Organization Active NPI

Fairlawn Podiatry Group PA

  • Podiatrist
  • Elmwood Park, NJ
National Provider Identifier
1710043740
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
FAIRLAWN PODIATRY GROUP PA
Practice address
1 Broadway Ste 105
Elmwood Park, NJ 07407-1843
Phone
(201) 797-3310
Fax
(201) 797-1977
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Authorized official

Name
Dr. Boris Raginsky, DPMNPI 1457352502
Title
Co Owner
Phone
(201) 797-3310

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

1 Broadway Ste 105
Elmwood Park, NJ 07407-1843

Mailing address

1 Broadway Ste 105
Elmwood Park, NJ 07407-1843
Phone (201) 797-3310

Other identifiers 2

IdentifierTypeStateIssuer
8024901MedicaidNJ
6702805MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040503001481 NJ Part B Supplier - Clinic/Group Practice 8527056126 Receives reassigned benefits from 1 practitioner
Practice locations: East Brunswick, NJ; Elmwood Park, NJ; Jersey City, NJ; Old Bridge, NJ
O20100930041684 NJ DME Supplier - Physician - Podiatry 8527056126 Practice locations: Elmwood Park, NJ

National Provider Directory

National Provider Directory

Locations

1 Broadway
Ste 401
Elmwood Park, NJ 07407

24-20 Broadway
Ste 4
Fair Lawn, NJ 07410
Phone (201) 797-3310

120 E Halsey Rd
Parsippany, NJ 07054
Phone (201) 667-6971

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1710043740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BROADWAY STE 105",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071843",
            "telephone_number": "201-797-3310",
            "fax_number": "201-797-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROADWAY STE 105",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071843",
            "telephone_number": "201-797-3310",
            "fax_number": "201-797-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLAWN PODIATRY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "RAGINSKY",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "201-797-3310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8024901",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6702805",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmwood Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.