NPIMap

Organization Active NPI

Active Podiatry LLC

  • Foot & Ankle Surgery Podiatrist
  • Wayne, NJ
National Provider Identifier
1093217622
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
25MD0032100 Issued in NJ
Legal business name
ACTIVE PODIATRY LLC
Doing business as
Active Podiatry LLC
Practice address
2035 Hamburg Tpke Ste B
Wayne, NJ 07470-6251
Phone
(201) 614-3668
Fax
(973) 256-4757
NPI assigned
Feb 28, 2018
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Homam Badri, DPMNPI 1093000465
Title
DPM
Phone
(201) 614-3668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 25MD0032100 NJ Primary

Addresses

Primary practice location

2035 Hamburg Tpke Ste B
Wayne, NJ 07470-6251

Mailing address

2035 Hamburg Tpke Ste B
Wayne, NJ 07470-6251
Phone (201) 614-3668

Other identifiers 1

IdentifierTypeStateIssuer
0429732MedicaidNJ

Other names 1

  • Active Podiatry LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1093217622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 HAMBURG TPKE STE B",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706251",
            "telephone_number": "201-614-3668",
            "fax_number": "973-256-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2035 HAMBURG TPKE STE B",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074706251",
            "telephone_number": "201-614-3668",
            "fax_number": "973-256-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2025-09-02",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "BADRI",
        "authorized_official_first_name": "HOMAM",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "201-614-3668",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD0032100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0429732",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Podiatry LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.