Healthcare Provider Details

I. General information

NPI: 1356377105
Provider Name (Legal Business Name): KALEIDOSCOPE MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 COVENTRY DR
PHILLIPSBURG NJ
08865-1978
US

IV. Provider business mailing address

410 COVENTRY CENTRE DR.
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-9902
  • Fax: 908-454-9905
Mailing address:
  • Phone: 908-454-9902
  • Fax: 908-454-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB065920
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNN095449NJ
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB077888000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06829400
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB064321
License Number StateNJ

VIII. Authorized Official

Name: DR. ANA P GOMES
Title or Position: PRESIDENT
Credential: D.O., CMD
Phone: 908-454-9902