Healthcare Provider Details

I. General information

NPI: 1689493553
Provider Name (Legal Business Name): MEDPAL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MADISON AVE
MORRISTOWN NJ
07960-6016
US

IV. Provider business mailing address

1000 THE AMERICAN RD UNIT 418
MORRIS PLAINS NJ
07950-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-656-2700
  • Fax:
Mailing address:
  • Phone: 516-301-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BEENISH FAHEEM
Title or Position: DIRECTOR
Credential: MD
Phone: 516-301-0748