MEDICARE: PARKSIDE HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1800X	Corporate Health Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1487652889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	STE 23
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-882-5200
Fax Number	:	609-882-0370

Provider Business Practice Location Address
First Line	:	1450 PARKSIDE AVE
Second Line	:	STE 23
City	:	EWING
State	:	NJ
Zip	:	08638-2946
Country	:	US
Telephone Number	:	609-882-5200
Fax Number	:	609-882-0370

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OBASI A. CHUKWUNENYE
Credential	:	M.D.
Telephone Number	:	609-882-5200

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	09/12/2007

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