MEDICARE: KEYSTONE GERIATRIC SPECIALISTS OF NEW JERSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1588527303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE GERIATRIC SPECIALISTS OF NEW JERSEY

Provider Business Mailing Address
First Line	:	3036 HIGHWAY 35 # 278
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W SPRING VALLEY AVE STE 200A
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1444
Country	:	US
Telephone Number	:	201-447-3690
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ARIADNE PANAGIOTOU
Credential	:
Telephone Number	:	201-447-3690

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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