| New Jersey Keystone Physicians,llc | |
|
1200 E Ridgewood Ave West Wing, Second Floor Ridgewood NJ 07450-3957 | |
| (201) 447-3690 | |
| (201) 447-3691 |
| Full Name | New Jersey Keystone Physicians,llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1200 E Ridgewood Ave, Ridgewood, New Jersey |
| Authorized Official Name and Position | Tina Panagiotou (OFFICE MANAGER) |
| Authorized Official Contact | 2014473690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Jersey Keystone Physicians,llc Po Box 115 Ridgewood NJ 07451-0115 Ph: (201) 447-3690 | New Jersey Keystone Physicians,llc 1200 E Ridgewood Ave West Wing, Second Floor Ridgewood NJ 07450-3957 Ph: (201) 447-3690 |
| NPI Number | 1457547887 |
|---|---|
| Provider Enumeration Date | 09/19/2007 |
| Last Update Date | 05/28/2013 |
| Medicare PECOS PAC ID | 1850514548 |
|---|---|
| Medicare Enrollment ID | O20140528000041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457547887 | NPI | - | NPPES |
| 087299 | Other | NJ | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25MAO7320300 (New Jersey) | Primary |
| Provider Name | Nicholas D Panagiotou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316987019 PECOS PAC ID: 2769431279 Enrollment ID: I20050121000267 |
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