Russell Samofal, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00323100 Issued in NJ

Practice address

510 Hamburg Tpke
Suite 108
Wayne, NJ 07470

Phone

(973) 925-4111

Fax

(973) 925-7711

NPI assigned

Jun 28, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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 1

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Podiatry Center of New Jersey LLCGroup PAC ID 7719293745, 15 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Podiatry Center of New Jersey, LLC

  • Podiatric Clinic/Center
  • Wayne, NJ
  • NPI 1932586708

  NJ, Podiatrist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1982968517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE",
            "address_2": "SUITE 108",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702025",
            "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",
            "address_2": "SUITE 108",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "07470",
            "telephone_number": "973-925-4111",
            "fax_number": "973-925-7711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "62 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Passaic",
            "state": "NJ",
            "postal_code": "070558412",
            "country_code": "US",
            "telephone_number": "973-925-4111",
            "fax_number": "973-925-7711",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6122 Bergenline Ave",
            "address_purpose": "LOCATION",
            "city": "West New York",
            "state": "NJ",
            "postal_code": "070931521",
            "country_code": "US",
            "telephone_number": "973-925-4111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMOFAL",
        "first_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-28",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00323100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maysoon Majdi Salem, OD
• Cynthia A Salerno
• Alexis Rae Saley, APN
• Carol Ann Salvatore, MSCCCSLP
• Nicole Michaela Salvemini
• Elkanah M Samoita
• Brad Samples II, D.P.T.
• Anish Samuel, MD
• Christian San Pedro, PT, DPT
• Deanna Marie Sanacore, APN

• All providers in Wayne, NJ
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.