New Jersey Keystone Physicians,LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MAO7320300 Issued in NJ

Legal business name

NEW JERSEY KEYSTONE PHYSICIANS,LLC

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 19, 2007

Last updated

May 28, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tina Panagiotou

Title

Office Manager

Phone

(201) 447-3690

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas D. Panagiotou, M.D, PH.D., M.S.

  • Family Medicine Physician
  • Ridgewood, NJ
  • NPI 1316987019
  Medicare reassignment

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1457547887",
    "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,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "PANAGIOTOU",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "201-447-3690",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "MEDICARE",
            "identifier": "087299",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.