Active NPI
Pedi-Care Corp
Doing business as Pedicare Orthotics & Prosthetics
- Prosthetic/Orthotic Supplier
- Lakewood, NJ
National Provider Identifier
1467757591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- 04003305999
- 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, 2025
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120816000791 | NJ | DME Supplier - Medical Supply Company With Orthotic Personnel | 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).
-
dba Pedicare Orthotics & Prosthetics
- Prosthetic/Orthotic Supplier
- Teaneck, NJ
- NPI 1376007898
7810143211
National Provider Directory
National Provider DirectoryLocations
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.