1073745535 NPI number — JACK GOLD SURGICAL APPLIANCES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073745535 NPI number — JACK GOLD SURGICAL APPLIANCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK GOLD SURGICAL APPLIANCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073745535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 EMERY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDOLPH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07869-1387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-328-3340
Provider Business Mailing Address Fax Number:
973-328-3342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25-09 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-444-7750
Provider Business Practice Location Address Fax Number:
201-612-1323
Provider Enumeration Date:
08/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CUFF
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-328-3340

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0225321 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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