KHALEIDOSCOPE HEALTH CARE INC. NPI 1336350909

NPI Information

NPI: 1336350909
Provider Name: KHALEIDOSCOPE HEALTH CARE INC.

Doing Business As: PARKSIDE MEDICAL CENTER

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
75 HARRISON AVENUE
JERSEY CITY, NJ
ZIP 07304
Phone: (201) 451-5425
Get Directions

KHALEIDOSCOPE HEALTH CARE INC. is a general practice dentist in Jersey City, NJ. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. KHALEIDOSCOPE HEALTH CARE INC. NPI is 1336350909. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Parkside Medical Center.

The provider's business location address is:

75 HARRISON AVENUE
JERSEY CITY, NJ
ZIP 07304-070
Phone: (201) 451-5425
Fax: (201) 451-7499

The provider's authorized official is Larry M Blake .
The authorized official title is Ceo and has the following contact phone number (201) 451-5425.

The CLIA number assigned to this NPI record is 31D0967009 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/25/2007 and was last updated on 12/5/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133NN1002X	Nutritionist	Nutrition, Education		NEW JERSEY	No
2	133V00000X	Dietitian, Registered			NEW JERSEY	No
3	2084P0800X	Psychiatry & Neurology	Psychiatry		NEW JERSEY	No
4	261QM1300X	Clinic/Center	Multi-Specialty		NEW JERSEY	No
5	261QM2800X	Clinic/Center	Methadone	22613	NEW JERSEY	No
6	1041C0700X	Social Worker	Clinical		NEW JERSEY	No
7	101YA0400X	Counselor	Addiction (Substance Use Disorder)		NEW JERSEY	No
8	1223G0001X	Dentist	General Practice		NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	6103201	MEDICAID	NEW JERSEY
2	7734301	MEDICAID	NEW JERSEY
3	7864108	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »