Organization
BLACK ROCK TPK MED GRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH FERNANDEZ (OFFICE ADMINISTRATOR)
(203) 334-7400
Entity
Organization
Contact information
Practice address
5520 PARK AVE, SUITE 203, TRUMBULL, CT 06611-3463
(203) 334-7400
(203) 338-0455
Mailing address
5520 PARK AVE, SUITE 203, TRUMBULL, CT 06611-3463
(203) 334-7400
(203) 338-0455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
013894
CT
207RH0003X
Hematology & Oncology Physician
—
CT
Other
Enumeration date
07/12/2005
Last updated
09/11/2025
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