Provider Demographics
NPI:1902299621
Name:KEYSTONE CARDIOVASCULAR CENTER LLC
Entity Type:Organization
Organization Name:KEYSTONE CARDIOVASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANAGIOTOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-956-4886
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-0040
Mailing Address - Country:US
Mailing Address - Phone:201-882-6088
Mailing Address - Fax:201-447-3691
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 200
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607
Practice Address - Country:US
Practice Address - Phone:201-882-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08814900261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty