NPIMap

Organization Active NPI

Medwell LLC

  • General Practice Physician
  • Midland Park, NJ
National Provider Identifier
1659384360
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEDWELL LLC
Practice address
33 Central Ave
Midland Park, NJ 07432
Phone
(201) 689-0800
Fax
(201) 689-0871
NPI assigned
Aug 14, 2006
Last updated
Nov 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

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

Authorized official

Name
Dr. Manouchehr T Shahab, MD
Title
Owner
Phone
(201) 819-1081

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
General Practice Physician 208D00000X Primary
Pain Medicine Physician 208VP0000X
Physical Therapist 225100000X

Addresses

Primary practice location

33 Central Ave
Midland Park, NJ 07432

Mailing address

33 Central Ave
Midland Park, NJ 07432
Phone (201) 689-0800

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722000847 NJ Part B Supplier - Clinic/Group Practice 9931189776 Receives reassigned benefits from 22 practitioners
Practice locations: Midland Park, NJ
O20100930023896 NJ DME Supplier - Multi-Specialty - Physician 9931189776 Practice locations: Midland Park, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2140939Medwell, LLC33 Central Avenue, Midland Park, NJ 07432Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory

Locations

33 Central Ave
Midland Park, NJ 07432
Phone (201) 447-9022

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1659384360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 CENTRAL AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "07432",
            "telephone_number": "201-689-0800",
            "fax_number": "201-689-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 CENTRAL AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "07432",
            "telephone_number": "201-689-0800",
            "fax_number": "201-689-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "SHAHAB",
        "authorized_official_first_name": "MANOUCHEHR",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-819-1081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.