| Cityblock Medical Practice | |
|
546 Eastern Pkwy Fl 1 Brooklyn NY 11225-1604 | |
| (000) 000-0000 | |
| Not Available |
| Full Name | Cityblock Medical Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 546 Eastern Pkwy Fl 1, Brooklyn, New York |
| Authorized Official Name and Position | Oluwatoyin Ajayi (PRESIDENT) |
| Authorized Official Contact | 8003361100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cityblock Medical Practice 495 Flatbush Ave Ste C5 Brooklyn NY 11225-3706 Ph: (800) 336-1100 | Cityblock Medical Practice 546 Eastern Pkwy Fl 1 Brooklyn NY 11225-1604 Ph: (000) 000-0000 |
| NPI Number | 1912491770 |
|---|---|
| Provider Enumeration Date | 06/15/2018 |
| Last Update Date | 05/25/2023 |
| Medicare PECOS PAC ID | 6608220389 |
|---|---|
| Medicare Enrollment ID | O20230928003498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912491770 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 292657-1 (New York) | Primary |
| Provider Name | Marney Gruber |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083857601 PECOS PAC ID: 9830345867 Enrollment ID: I20150720000450 |
| Provider Name | Oluwatoyin Ajayi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790912426 PECOS PAC ID: 7517115298 Enrollment ID: I20180709001208 |
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