NPIMap

Organization Active NPI

Black Rock TPK Med GRP

  • Internal Medicine Physician
  • Trumbull, CT
National Provider Identifier
1295733491
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
013894 Issued in CT
Legal business name
BLACK ROCK TPK MED GRP
Practice address
5520 Park Ave
Suite 203
Trumbull, CT 06611-3463
Phone
(203) 334-7400
Fax
(203) 338-0455
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elizabeth Fernandez
Title
Office Administrator
Phone
(203) 334-7400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 013894 CT Primary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X CT

Addresses

Primary practice location

5520 Park Ave
Suite 203
Trumbull, CT 06611-3463

Mailing address

5520 Park Ave
Suite 203
Trumbull, CT 06611-3463
Phone (203) 334-7400

National Provider Directory

National Provider Directory

Locations

5520 Park Ave
Ste 203
Trumbull, CT 06611
Phone (203) 334-7400

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1295733491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5520 PARK AVE",
            "address_2": "SUITE 203",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113463",
            "telephone_number": "203-334-7400",
            "fax_number": "203-338-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5520 PARK AVE",
            "address_2": "SUITE 203",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113463",
            "telephone_number": "203-334-7400",
            "fax_number": "203-338-0455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK ROCK TPK MED GRP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "203-334-7400"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "013894",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.