Provider Demographics
NPI:1497797898
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:P
Authorized Official - Last Name:CUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-328-3340
Mailing Address - Street 1:300 EAST BROWN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3007
Mailing Address - Country:US
Mailing Address - Phone:570-420-9900
Mailing Address - Fax:570-420-4529
Practice Address - Street 1:300 EAST BROWN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3007
Practice Address - Country:US
Practice Address - Phone:570-420-9900
Practice Address - Fax:570-420-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005108335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073257880003Medicaid
PA0149900004Medicare NSC