Organization
KHALEIDOSCOPE HEALTH CARE INC.
Active
Other names
Parkside Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY M BLAKE JR. LCSW (CEO)
(201) 386-9264
Entity
Organization
Contact information
Practice address
127 LAFAYETTE ST, JERSEY CITY, NJ 07304-3615
(201) 451-5425
(201) 451-7499
Mailing address
P.O BOX 4070 75 HARRISON AVE, JERSEY CITY, NJ 07304-0070
(201) 451-5425
(201) 451-7499
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
80305
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103201
—
NJ
05
—
7864108
—
NJ
Enumeration date
04/09/2007
Last updated
11/27/2023
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