NPIMap

Organization Active NPI

Premier Podiatry, L.L.C.

  • Foot & Ankle Surgery Podiatrist
  • Wayne, NJ
National Provider Identifier
1417524224
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PREMIER PODIATRY, L.L.C.
Practice address
502 Hamburg Tpke Ste 105
Wayne, NJ 07470-8446
Phone
(973) 384-4444
Fax
(866) 756-0438
NPI assigned
Jun 9, 2021
Last updated
Jan 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Dr. Velimir R Petkov, DPMNPI 1932372638
Title
President/ Owner
Phone
(917) 667-4585

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
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

502 Hamburg Tpke Ste 105
Wayne, NJ 07470-8446

Mailing address

925 Clifton Ave Ste 108
Clifton, NJ 07013-2724
Phone (973) 315-5555

National Provider Directory

National Provider Directory
Tax ID family
Premier Podiatry LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18768/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1417524224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CLIFTON AVE STE 108",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132724",
            "telephone_number": "973-315-5555",
            "fax_number": "866-756-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 HAMBURG TPKE STE 105",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074708446",
            "telephone_number": "973-384-4444",
            "fax_number": "866-756-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PODIATRY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "PETKOV",
        "authorized_official_first_name": "VELIMIR",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/ OWNER",
        "authorized_official_telephone_number": "917-667-4585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jan 29, 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.