Provider Demographics
NPI:1962405902
Name:CG MEDICAL, INC.
Entity type:Organization
Organization Name:CG MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO,LPO
Authorized Official - Phone:732-545-2885
Mailing Address - Street 1:1501 LIVINGSTON AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1876
Mailing Address - Country:US
Mailing Address - Phone:732-545-2885
Mailing Address - Fax:732-545-0153
Practice Address - Street 1:1501 LIVINGSTON AVE
Practice Address - Street 2:STE 103
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1876
Practice Address - Country:US
Practice Address - Phone:732-545-2885
Practice Address - Fax:732-545-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00002700335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1056204Medicaid
NJ1056204Medicaid