Organization Active NPI

Foot and Ankle Center of NJ & Ny LLC

  • Podiatrist
  • Fort Lee, NJ
National Provider Identifier
1356123293
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
FOOT AND ANKLE CENTER OF NJ & NY LLC
Practice address
2225 Lemoine Ave FL 1
Fort Lee, NJ 07024-6104
Phone
(201) 363-9844
Fax
(201) 363-9662
NPI assigned
Oct 16, 2023
Last updated
Aug 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Authorized official

Name
Gavriil KhaimovNPI 1669483426
Title
Owner
Phone
(201) 363-9844

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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

2225 Lemoine Ave FL 1
Fort Lee, NJ 07024-6104

Mailing address

2225 Lemoine Ave FL 1
Fort Lee, NJ 07024-6104
Phone (201) 363-9844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20240125001277 NJ Part B Supplier - Clinic/Group Practice 2365895406 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Lee, NJ; Englewood, NJ
O20250109000007 NJ DME Supplier - Physician - Podiatry 2365895406 Practice locations: Fort Lee, NJ
O20250402000570 NY Part B Supplier - Clinic/Group Practice 2365895406 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY; Flushing, NY; Forest Hills, NY

National Provider Directory

National Provider Directory

Locations

2225 Lemoine Ave
#1
Fort Lee, NJ 07024
Phone (201) 363-9844

6939 Yellowstone Blvd
Ste 11
Forest Hills, NY 11375
Phone (718) 575-3668

Practitioners & affiliated clinicians

Practitioners 3

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": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786406400000",
    "number": "1356123293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 LEMOINE AVE FL 1",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246104",
            "telephone_number": "201-363-9844",
            "fax_number": "201-363-9662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 LEMOINE AVE FL 1",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246104",
            "telephone_number": "201-363-9844",
            "fax_number": "201-363-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE CENTER OF NJ & NY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A",
        "authorized_official_last_name": "KHAIMOV",
        "authorized_official_first_name": "GAVRIIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-363-9844"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lee, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.