Organization
NEW JERSEY KEYSTONE PHYSICIANS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS DEMETRIOS PANAGIOTOU M.D. (MEDICAL DIRECTOR)
(201) 447-3690
Entity
Organization
Contact information
Practice address
1200 E RIDGEWOOD AVE, WEST WING, SECOND FLOOR, RIDGEWOOD, NJ 07450-3957
(201) 447-3690
(201) 447-3691
Mailing address
PO BOX 115, RIDGEWOOD, NJ 07451-0115
(201) 447-3690
(201) 447-3691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MAO7320300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
087299
MEDICARE
NJ
01
—
201973014
BUSINESS TAX ID
NJ
Enumeration date
09/18/2007
Last updated
05/28/2013
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