Organization Active NPI

Active Podiatry PLLC

  • Foot Surgery Podiatrist
  • Brooklyn, NY
National Provider Identifier
1184135568
Registry record updated Feb 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
Legal business name
ACTIVE PODIATRY PLLC
Practice address
149 Marine Ave Apt la
Brooklyn, NY 11209-7712
Phone
(718) 883-8844
NPI assigned
Oct 12, 2017
Last updated
Feb 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2018

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

Authorized official

Name
Wiqar Farooqi
Title
DPM
Phone
(516) 286-9853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X NU Primary

Addresses

Primary practice location

149 Marine Ave Apt la
Brooklyn, NY 11209-7712

Mailing address

149 Marine Ave Apt la
Brooklyn, NY 11209-7712
Phone (718) 883-8844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180126001076 NY Part B Supplier - Clinic/Group Practice 9436419124 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY
O20190204001937 NY DME Supplier - Physician - Podiatry 9436419124 Practice locations: Brooklyn, NY

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": "1507766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1184135568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 MARINE AVE APT LA",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112097712",
            "telephone_number": "718-883-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 MARINE AVE APT LA",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112097712",
            "telephone_number": "718-883-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE PODIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-12",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "FAROOQI",
        "authorized_official_first_name": "WIQAR",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "516-286-9853"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.