| Geriatrics And Longevity Treatment Specialist, Pc | |
|
810 Main St Hackensack NJ 07601-4847 | |
| (201) 663-7375 | |
| Not Available |
| Full Name | Geriatrics And Longevity Treatment Specialist, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 810 Main St, Hackensack, New Jersey |
| Authorized Official Name and Position | Stefanos G Pantagis (OWNER) |
| Authorized Official Contact | 2016637375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geriatrics And Longevity Treatment Specialist, Pc 810 Main St Hackensack NJ 07601-4847 Ph: (201) 663-7375 | Geriatrics And Longevity Treatment Specialist, Pc 810 Main St Hackensack NJ 07601-4847 Ph: (201) 663-7375 |
| NPI Number | 1306121504 |
|---|---|
| Provider Enumeration Date | 10/19/2011 |
| Last Update Date | 11/13/2013 |
| Medicare PECOS PAC ID | 3072787308 |
|---|---|
| Medicare Enrollment ID | O20111122000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306121504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Stefanos G Pantagis |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1235212879 PECOS PAC ID: 2163318783 Enrollment ID: I20040223000286 |
| Provider Name | Clare E Rovito |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669583621 PECOS PAC ID: 3375542848 Enrollment ID: I20061211000201 |
| Provider Name | Gina L Dicostanzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306927314 PECOS PAC ID: 2860540945 Enrollment ID: I20090429000229 |
| Provider Name | Daniel J Herera |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1164424958 PECOS PAC ID: 6204987548 Enrollment ID: I20090629000008 |
| Provider Name | Mary Ann Schran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609877281 PECOS PAC ID: 7315078136 Enrollment ID: I20100623000289 |
| Provider Name | Eun Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700140217 PECOS PAC ID: 1658522651 Enrollment ID: I20121126000396 |
| Provider Name | Anna Wolfson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831430800 PECOS PAC ID: 1355584053 Enrollment ID: I20130828000499 |
| Provider Name | Susanthi Gunadasa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639331861 PECOS PAC ID: 0143467456 Enrollment ID: I20131101001530 |
| Provider Name | Mary L Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386040905 PECOS PAC ID: 0547587693 Enrollment ID: I20150330000370 |
| Provider Name | Tamar Shicly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427430149 PECOS PAC ID: 3971819830 Enrollment ID: I20160923000069 |
| Provider Name | Mary Grace Tolentino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578000550 PECOS PAC ID: 3870879729 Enrollment ID: I20170408000018 |
| Provider Name | Dana A Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285157479 PECOS PAC ID: 1759653694 Enrollment ID: I20170828000874 |
| Provider Name | Michael D Abbey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942743752 PECOS PAC ID: 1951675719 Enrollment ID: I20170919000427 |
| Provider Name | Lorna B Pazziuagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457840134 PECOS PAC ID: 3779828736 Enrollment ID: I20181219000914 |
| Provider Name | Felicidad Marie I Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083199160 PECOS PAC ID: 1759628670 Enrollment ID: I20190130000588 |
| Provider Name | Jessica P Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700361698 PECOS PAC ID: 8527308378 Enrollment ID: I20190314001429 |
| Provider Name | Beverly Piparo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255973137 PECOS PAC ID: 5890127815 Enrollment ID: I20191113001961 |
| Provider Name | Jennifer J Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295371813 PECOS PAC ID: 5597196774 Enrollment ID: I20200505000017 |
| Provider Name | Christian Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427723501 PECOS PAC ID: 0840683181 Enrollment ID: I20220208002798 |
| Provider Name | Amy E Donoghue |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841343498 PECOS PAC ID: 3779681010 Enrollment ID: I20220309002578 |
| Provider Name | Colleen Doran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609204957 PECOS PAC ID: 7315309564 Enrollment ID: I20230821000199 |
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