Khaleidoscope Health Care Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KHALEIDOSCOPE HEALTH CARE INC.

Doing business as

Parkside Medical Center

Practice address

75 Harrison Avenue
Jersey City, NJ 07304-0070

Phone

(201) 451-5425

Fax

(201) 451-7499

NPI assigned

May 25, 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, LCSW

Title

Ceo

Phone

(201) 451-5425

Specialties & licenses 8

Addresses

Other identifiers 3

Other names 1

• Parkside Medical Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opioid treatment program

Medicare-enrolled since Apr 11, 2026

Tax ID family

Khaleidoscope Health Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Khaleidoscope Health Care Inc

  • Non-emergency Medical Transport (VAN)
  • Jersey City, NJ
  • NPI 1750645834
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rhonda Ann Hagler, M.D.

  • Internal Medicine Physician
  • Lyndhurst, NJ
  • NPI 1487666202
  NPD

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1336350909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4070",
            "address_2": "75 HARRISON AVENUE",
            "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": "75 HARRISON AVENUE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073040070",
            "telephone_number": "201-451-5425",
            "fax_number": "201-451-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHALEIDOSCOPE HEALTH CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "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": "201-451-5425",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NJ",
            "license": "22613",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7734301",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103201",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7864108",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Bahaa Khalil

• General Practice Dentistry in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.