Individual provider Active NPI

Philip J Cynamon, DPM

  • Podiatrist
  • Wayne, NJ
National Provider Identifier
1669053294
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
25MD00380000 Issued in NJ
Practice address
510 Hamburg Tpke Ste 108
Wayne, NJ 07470-2033
Phone
(973) 925-4111
Fax
(973) 925-7711
NPI assigned
Apr 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Podiatrist 213E00000X 25MD00380000 NJ Primary

Addresses

Primary practice location

510 Hamburg Tpke Ste 108
Wayne, NJ 07470-2033

Mailing address

510 Hamburg Tpke Ste 108
Wayne, NJ 07470-2033
Phone (973) 925-4111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240508003462 NJ Practitioner - Podiatry 4385085331 Reassigns benefits to 1 organization
I20250401000665 NY Practitioner - Podiatry 4385085331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Parcare Community Health Network IncGroup PAC ID 4981823390, 99 clinicians

Practice addresses (Care Compare)

445 Park Ave
Brooklyn, NY 11205-2735
Phone (718) 963-0800

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue61
Removal of skin lesions85
Removal of nail tissue179
Removal or shaving of skin growth46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25MD00380000NJMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Podiatry Center of New Jersey, LLC Podiatrist CurrentSince May 1, 2024 Accepting new patients
Parcare Community Health Network Inc CurrentSince Mar 1, 2025 Accepting new patients
Parcare Community Health Network Inc CurrentSince Mar 1, 2025 Accepting new patients

Locations

510 Hamburg Tpke
Ste 108
Wayne, NJ 07470
Phone (718) 431-4979

4714 16th Ave
Brooklyn, NY 11204
Phone (212) 604-9800

445 Park Ave
Brooklyn, NY 11205
Phone (718) 965-1320

6010 Bay Pkwy
Ste 902
Brooklyn, NY 11204
Phone (718) 475-1700

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1669053294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE STE 108",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702033",
            "telephone_number": "973-925-4111",
            "fax_number": "973-925-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE STE 108",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702033",
            "telephone_number": "973-925-4111",
            "fax_number": "973-925-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CYNAMON",
        "first_name": "PHILIP",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00380000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

Verify at the official NPI Registry.