NPIMap

Organization Active NPI

Innovative Foot and Ankle, P.a.

  • Primary Podiatric Medicine Podiatrist
  • Kenilworth, NJ
National Provider Identifier
1023177532
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
25MD00261900 Issued in NJ
Legal business name
INNOVATIVE FOOT AND ANKLE, P.A.
Practice address
528 Boulevard
Kenilworth, NJ 07033-1657
Phone
(908) 276-6624
Fax
(908) 709-0163
NPI assigned
Dec 8, 2006
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sean L Kaufman, D.P.M.NPI 1821091018
Title
Owner
Phone
(908) 276-6624

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 25MD00261900 NJ Primary

Addresses

Primary practice location

528 Boulevard
Kenilworth, NJ 07033-1657

Mailing address

528 Boulevard
Kenilworth, NJ 07033-1657
Phone (908) 276-6624

Other identifiers 1

IdentifierTypeStateIssuer
8719501MedicaidNJ

Other names 1

  • Daniel Brandwein DPM and Sean Kaufman DPM Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060720000037 NJ Part B Supplier - Clinic/Group Practice 7315950268 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Bayonne, NJ; Kenilworth, NJ; Montclair, NJ
O20100930019117 NJ DME Supplier - Physician - PodiatryDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 7315950268 Practice locations: Kenilworth, NJ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Innovative Foot and Ankle PA528 Boulevard, Kenilworth, NJ 07033-1657(908) 276-6624 Orthoses: Custom Fabricated|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory

Locations

528 Boulevard
Ste 2
Kenilworth, NJ 07033

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1023177532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 BOULEVARD",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331657",
            "telephone_number": "908-276-6624",
            "fax_number": "908-709-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 BOULEVARD",
            "city": "KENILWORTH",
            "state": "NJ",
            "postal_code": "070331657",
            "telephone_number": "908-276-6624",
            "fax_number": "908-709-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE FOOT AND ANKLE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "KAUFMAN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-276-6624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NJ",
            "license": "25MD00261900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8719501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Daniel Brandwein DPM and Sean Kaufman DPM",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kenilworth, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.