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Contact Information

ACTIVE PODIATRY LLC
2035 HAMBURG TPKE STE B
WAYNE, NJ07470-6251
 Phone: 201-614-3668
 Fax: 973-256-4757
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for ACTIVE PODIATRY LLC · (Female)

NPI Number 1093217622
Status Active
Credentials
Entity Individual
Enumeration date 02/28/2018
Last updated 09/02/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • NJ License # 25MD0032100
  • NJ Medicaid 0429732
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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