Healthcare Provider Details

I. General information

NPI: 1104821495
Provider Name (Legal Business Name): JACK GOLD SURGICAL APPLIANCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL DR SUITE A5
TOMS RIVER NJ
08755-6425
US

IV. Provider business mailing address

1 EMERY AVENUE
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 732-341-9191
  • Fax: 732-341-9222
Mailing address:
  • Phone: 973-328-3340
  • Fax: 973-328-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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