Basic Information
Provider Information | |||||||||
NPI: | 1063404796 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BESS | ||||||||
FirstName: | ANGELA | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MEYER | ||||||||
OtherFirstName: | ANGELA | ||||||||
OtherMiddleName: | CHRISTINE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 401 YOUNG AVE STE 325 | ||||||||
Address2: |   | ||||||||
City: | MOORESTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 080574800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8562918865 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 401 YOUNG AVE STE 325 | ||||||||
Address2: |   | ||||||||
City: | MOORESTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 080574800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8562918865 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/18/2005 | ||||||||
LastUpdateDate: | 10/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101236781 | VA | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 25MA07079700 | NJ | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 010120802 | 05 | VA |   | MEDICAID |