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Organization
KHALEIDOSCOPE HEALTH CARE INC.
Active
Organization
KHALEIDOSCOPE HEALTH CARE INC.
Active
Other names
Parkside Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY M BLAKE LCSW (CEO)
(201) 451-5425
Entity
Organization
Contact information
Practice address
75 HARRISON AVENUE, JERSEY CITY, NJ 07304-0070
(201) 451-5425
(201) 451-7499
Mailing address
P.O. BOX 4070, 75 HARRISON AVENUE, JERSEY CITY, NJ 07304-0070
(201) 451-5425
(201) 451-7499
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NJ
1041C0700X
Clinical Social Worker
—
NJ
1223G0001X
General Practice Dentistry
Primary
—
NJ
133NN1002X
Nutrition Education Nutritionist
—
NJ
133V00000X
Registered Dietitian
—
NJ
2084P0800X
Psychiatry Physician
—
NJ
261QM1300X
Multi-Specialty Clinic/Center
—
NJ
261QM2800X
Methadone Clinic
22613
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103201
—
NJ
05
—
7734301
—
NJ
05
—
7864108
—
NJ
Enumeration date
05/25/2007
Last updated
10/06/2023
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