Healthcare Provider Details

I. General information

NPI: 1588527303
Provider Name (Legal Business Name): KEYSTONE GERIATRIC SPECIALISTS OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W SPRING VALLEY AVE STE 200A
MAYWOOD NJ
07607-1444
US

IV. Provider business mailing address

3036 HIGHWAY 35 # 278
HAZLET NJ
07730-1505
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-3690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIADNE PANAGIOTOU
Title or Position: MD
Credential:
Phone: 201-447-3690