Provider Demographics
NPI:1760946974
Name:ADVANCED MEDICAL & COSMETIC CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL & COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:N
Authorized Official - Last Name:PANAGIOTOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-882-1050
Mailing Address - Street 1:208 HARRISTOWN RD # LL-2A
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3308
Mailing Address - Country:US
Mailing Address - Phone:201-882-1050
Mailing Address - Fax:201-882-1040
Practice Address - Street 1:208 HARRISTOWN RD # LL-2A
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3308
Practice Address - Country:US
Practice Address - Phone:201-882-1050
Practice Address - Fax:201-882-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty