MEDICARE: CG MEDICAL, 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
1	335E00000X	Prosthetic/Orthotic Supplier	45PO00002700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962405902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CG MEDICAL, INC.

Provider Business Mailing Address
First Line	:	1501 LIVINGSTON AVE
Second Line	:	STE 103
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-1876
Country	:	US
Telephone Number	:	732-545-2885
Fax Number	:	732-545-0153

Provider Business Practice Location Address
First Line	:	1501 LIVINGSTON AVE
Second Line	:	STE 103
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-1876
Country	:	US
Telephone Number	:	732-545-2885
Fax Number	:	732-545-0153

Authorized Official
Title or Position	:	PROSTHETIST/ORTHOTIST
Name	:	MR. CAREY A GLASS
Credential	:	CPO,LPO
Telephone Number	:	732-545-2885

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/12/2008

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