Provider Demographics
NPI:1215179627
Name:KEYSTONE GROUP, LLC
Entity Type:Organization
Organization Name:KEYSTONE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-660-9334
Mailing Address - Street 1:25B VREELAND RD STE 110
Mailing Address - Street 2:PO BOX 0037
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1928
Mailing Address - Country:US
Mailing Address - Phone:973-660-9334
Mailing Address - Fax:973-660-9732
Practice Address - Street 1:25B VREELAND RD STE 110
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1928
Practice Address - Country:US
Practice Address - Phone:973-660-9334
Practice Address - Fax:973-660-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty