New Jersey Keystone Physicians,PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MAO7320300 Issued in NJ

Legal business name

NEW JERSEY KEYSTONE PHYSICIANS,PA

Practice address

1200 E Ridgewood Ave
West Wing, Second Floor
Ridgewood, NJ 07450-3957

Phone

(201) 447-3690

Fax

(201) 447-3691

NPI assigned

Sep 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nicholas Demetrios Panagiotou, M.D.

Title

Medical Director

Phone

(201) 447-3690

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hui Guo, MD

  • Internal Medicine Physician
  • North Brunswick, NJ
  • NPI 1154595692
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1215123732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 115",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074510115",
            "telephone_number": "201-447-3690",
            "fax_number": "201-447-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E RIDGEWOOD AVE",
            "address_2": "WEST WING, SECOND FLOOR",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503957",
            "telephone_number": "201-447-3690",
            "fax_number": "201-447-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY KEYSTONE PHYSICIANS,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "PANAGIOTOU",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "DEMETRIOS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-447-3690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MAO7320300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS TAX ID",
            "identifier": "201973014",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "087299",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nikitas Nicholaides, MS, ATC, CSCS, CFST2
• Matthew Nicholas, LSW

• All providers in Ridgewood, NJ
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.