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General NPI Number Information
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NPI Number | 1962405902
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Entity Type | Organization
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Legal Business Name | CG MEDICAL, INC.
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1501 LIVINGSTON AVE STE 103
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1876
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Country | US
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Telephone | 732-545-2885
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Fax | 732-545-0153
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Provider Business Mailing Address
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Address Line | 1501 LIVINGSTON AVE STE 103
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1876
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Country | US
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Telephone | 732-545-2885
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Fax | 732-545-0153
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Authorized Official
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Title or Position | PROSTHETIST/ORTHOTIST
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Name | MR. CAREY A GLASS
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Credential | CPO,LPO
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Telephone | 732-545-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 45PO00002700
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License Number State | NJ
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