Khaleidoscope Health Care Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

80305 Issued in NJ

Legal business name

KHALEIDOSCOPE HEALTH CARE INC.

Doing business as

Parkside Medical Center

Practice address

127 Lafayette St
Jersey City, NJ 07304-3615

Phone

(201) 451-5425

Fax

(201) 451-7499

NPI assigned

Apr 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Larry M Blake Jr., LCSW

Title

Ceo

Phone

(201) 386-9264

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Parkside Medical Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1306969787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 4070 75 HARRISON AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073040070",
            "telephone_number": "201-451-5425",
            "fax_number": "201-451-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 LAFAYETTE ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073043615",
            "telephone_number": "201-451-5425",
            "fax_number": "201-451-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHALEIDOSCOPE HEALTH CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "201-386-9264",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "80305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7864108",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parkside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Colleen Jaime Kenny
• Patricia Marie Kenny, RPH
• Elyse B Kerschner, D.D.S.
• Samantha Kerstein
• Khaleidoscope Health Care Inc
• Khaleidoscope Health Care Inc.
• Ronny Fares Khalek, DDS
• Amtul Khaleq, M.D.
• Aysha Khalid, M.D.
• Umair Khalid, PT

• Primary Care Clinic/Center in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.