# KEYSTONE INTERNAL MEDICINE AND WEIGHT LOSS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871151118
- **Authorized official:** DR. POLLYTIA IRENE PANAGIOTOU MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (201) 447-3690

## Contact information

- **Practice address:** 255 WEST SPRING VALLEY AVE, SECOND FLOOR, SUITE 200, MAYWOOD, NJ 07607
- **Practice address phone:** (201) 447-3690
- **Mailing address:** PO BOX 1461, RIDGEWOOD, NJ 07451-1461
- **Mailing address phone:** (201) 450-6044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/02/2019
- **Last updated:** 06/27/2019