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NPI Code Detail

MEDICARE: JACK GOLD SURGICAL APPLIANCES, INC.

MEDICARE: JACK GOLD SURGICAL APPLIANCES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1689266306
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACK GOLD SURGICAL APPLIANCES, INC.
Provider Business Mailing Address
First Line : 1900 S BROAD ST STE B
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2304
Country : US
Telephone Number : 215-829-5733
Fax Number : 267-892-3734
Provider Business Practice Location Address
First Line : 1900 S BROAD ST STE B
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2304
Country : US
Telephone Number : 267-443-1066
Fax Number : 267-892-3734
Authorized Official
Title or Position : CEO
Name : IVAN SABEL
Credential :
Telephone Number : 973-328-3340
Provider Enumeration Date : 02/04/2021
Last Update Date : 05/19/2026

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