Organization Active NPI

Pedi-Care Corp

Doing business as Pedicare Orthotics & Prosthetics

  • Prosthetic/Orthotic Supplier
  • Lakewood, NJ
National Provider Identifier
1467757591
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
04003305999 Issued in NJ
Legal business name
PEDI-CARE CORP
Doing business as
Pedicare Orthotics & Prosthetics
Practice address
1352 River Ave Ste 4
Lakewood, NJ 08701-5646
Phone
(732) 415-2318
Fax
(732) 584-2786
NPI assigned
Jan 21, 2011
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Raizel Rosenberg
Title
President
Phone
(732) 415-2318

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Prosthetic/Orthotic Supplier 335E00000X 04003305999 NJ Primary

Addresses

Primary practice location

1352 River Ave Ste 4
Lakewood, NJ 08701-5646

Mailing address

1352 River Ave Ste 4
Lakewood, NJ 08701-5646
Phone (732) 415-2318

Other practice location 1

1086 Teaneck Rd Ste 3F1
Teaneck, NJ 07666-4855
Phone (201) 666-6647

Other names 1

  • PEDICARE ORTHOTICS & PROSTHETICS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120816000791 NJ DME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Certified Orth/Pros/Pedorthist 7810143211 Practice locations: Lakewood, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1086 Teaneck Rd
Ste 3F1
Teaneck, NJ 07666
Phone (201) 666-6647

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1467757591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1352 RIVER AVE STE 4",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015646",
            "telephone_number": "732-415-2318",
            "fax_number": "732-584-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1352 RIVER AVE STE 4",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015646",
            "telephone_number": "732-415-2318",
            "fax_number": "732-584-2786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1086 Teaneck Rd Ste 3F1",
            "address_purpose": "LOCATION",
            "city": "Teaneck",
            "state": "NJ",
            "postal_code": "076664855",
            "country_code": "US",
            "telephone_number": "201-666-6647",
            "fax_number": "201-676-8828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDI-CARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "RAIZEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-415-2318"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NJ",
            "license": "04003305999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDICARE ORTHOTICS & PROSTHETICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; 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.