Provider Demographics
NPI:1285638981
Name:JACK GOLD SURGICAL APPLIANCES, INC.
Entity Type:Organization
Organization Name:JACK GOLD SURGICAL APPLIANCES, INC.
Other - Org Name:ALLIEDOP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-328-3340
Mailing Address - Street 1:1 EMERY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1387
Mailing Address - Country:US
Mailing Address - Phone:973-328-3340
Mailing Address - Fax:973-328-3342
Practice Address - Street 1:813 E GATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1238
Practice Address - Country:US
Practice Address - Phone:856-243-6400
Practice Address - Fax:856-273-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0078924335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3450601Medicaid