ACTIVE PODIATRY LLC; NPI #1093217622

Contact Information

ACTIVE PODIATRY LLC

2035 HAMBURG TPKE STE B
WAYNE, NJ 07470-6251

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

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NPI Profile & details for ACTIVE PODIATRY LLC

NPI # 1093217622

LBN Legal business name ACTIVE PODIATRY LLC

Authorized official HOMAM BADRI - (DPM)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/28/2018

Last updated 09/02/2025 - About 9 months ago

Identifiers

NJ	License #	25MD0032100
NJ	Medicaid	0429732

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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