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General NPI Number Information
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NPI Number | 1740578079
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Entity Type | Organization
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Legal Business Name | JGM GROUP INC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 68 JAY ST STE 421
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City | BROOKLYN
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State | NY
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Zip | 11201-8310
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Country | US
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Telephone | 888-898-5367
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Fax |
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Provider Business Mailing Address
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Address Line | 12 HALL ST
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City | BROOKLYN
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State | NY
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Zip | 11205-1304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISING OPTICIAN
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Name | MR. JOSE ANTHONY GONZALES
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Credential | L.D.O
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Telephone | 888-898-5367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5743-1
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License Number State | NY
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