| New Jersey Keystone Physicians,pa | |
|
1200 E Ridgewood Ave West Wing, Second Floor Ridgewood NJ 07450-3957 | |
| (201) 447-3690 | |
| (201) 447-3691 |
| Full Name | New Jersey Keystone Physicians,pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1200 E Ridgewood Ave, Ridgewood, New Jersey |
| Authorized Official Name and Position | Nicholas Demetrios Panagiotou (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2014473690 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Jersey Keystone Physicians,pa Po Box 115 Ridgewood NJ 07451-0115 Ph: (201) 447-3690 | New Jersey Keystone Physicians,pa 1200 E Ridgewood Ave West Wing, Second Floor Ridgewood NJ 07450-3957 Ph: (201) 447-3690 |
| NPI Number | 1215123732 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 05/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215123732 | NPI | - | NPPES |
| 201973014 | Other | NJ | BUSINESS TAX ID |
| 087299 | Other | NJ | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25MAO7320300 (New Jersey) | Primary |
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