Healthcare Provider Details

I. General information

NPI: 1093000465
Provider Name (Legal Business Name): HOMAM BADRI D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 HAMBURG TPKE STE B
WAYNE NJ
07470-6251
US

IV. Provider business mailing address

4 OVERHILL RD
WAYNE NJ
07470-6282
US

V. Phone/Fax

Practice location:
  • Phone: 201-614-3668
  • Fax:
Mailing address:
  • Phone: 973-330-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD0032100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: