Healthcare Provider Details

I. General information

NPI: 1558334896
Provider Name (Legal Business Name): JACK GOLD SURGICAL APPLIANCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/04/2021
Certification Date: 04/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EMERY AVE
RANDOLPH NJ
07869-1308
US

IV. Provider business mailing address

1 EMERY AVE
RANDOLPH NJ
07869-1308
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-3340
  • Fax: 973-584-3237
Mailing address:
  • Phone: 973-328-3340
  • Fax: 973-584-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN P CUFF
Title or Position: PRESIDENT
Credential:
Phone: 973-328-3340