Organization
CITYBLOCK MEDICAL PRACTICE CT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN ITSKOV (CREDENTIALING)
(347) 401-1399
Entity
Organization
Contact information
Practice address
76 CENTER ST FL 3, WATERBURY, CT 06702-2129
(203) 518-4566
Mailing address
55 WASHINGTON ST STE 552, BROOKLYN, NY 11201-1089
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
01/03/2019
Last updated
02/06/2019
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