Healthcare Provider Details

I. General information

NPI: 1174590855
Provider Name (Legal Business Name): CG MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MINNEAKONING RD
FLEMINGTON NJ
08822-5725
US

IV. Provider business mailing address

1501 LIVINGSTON AVE SUITE 103
NORTH BRUNSWICK NJ
08902-1876
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-9159
  • Fax: 732-545-0153
Mailing address:
  • Phone: 732-545-2885
  • Fax: 732-545-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number45PO00002700
License Number StateNJ

VIII. Authorized Official

Name: MR. CAREY A GLASS
Title or Position: PROSTHETIST/ORTHOTIST
Credential: CPO,LPO,FAAOP
Phone: 908-788-9159