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Organization
KEYSTONE INTERNAL MEDICINE AND WEIGHT LOSS CENTER LLC
Active
Organization
KEYSTONE INTERNAL MEDICINE AND WEIGHT LOSS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POLLYTIA IRENE PANAGIOTOU MD (MEDICAL DIRECTOR)
(201) 447-3690
Entity
Organization
Contact information
Practice address
255 WEST SPRING VALLEY AVE, SECOND FLOOR, SUITE 200, MAYWOOD, NJ 07607
(201) 447-3690
Mailing address
PO BOX 1461, RIDGEWOOD, NJ 07451-1461
(201) 450-6044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/02/2019
Last updated
06/27/2019
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