Provider Demographics
NPI:1578775896
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 1:1 EMERY AVE
Mailing Address - Street 2:
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:973-328-3340
Practice Address - Street 1:190 BRODHEAD RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8617
Practice Address - Country:US
Practice Address - Phone:610-954-0180
Practice Address - Fax:610-954-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004016335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073257880002Medicaid
PA0149900003Medicare NSC