# MEDWELL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659384360
- **Authorized official:** DR. MANOUCHEHR T SHAHAB MD (OWNER)
- **Authorized official phone:** (201) 819-1081

## Contact information

- **Practice address:** 33 CENTRAL AVE, MIDLAND PARK, NJ 07432
- **Practice address phone:** (201) 689-0800
- **Practice address fax:** (201) 689-0871
- **Mailing address:** 33 CENTRAL AVE, MIDLAND PARK, NJ 07432
- **Mailing address phone:** (201) 689-0800
- **Mailing address fax:** (201) 689-0871

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 11/12/2008