Cityblock Medical Practice CT, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CITYBLOCK MEDICAL PRACTICE CT, P.C.

Practice address

76 Center St FL 3
Waterbury, CT 06702-2129

Phone

(203) 518-4566

NPI assigned

Jan 3, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Itskov

Title

Credentialing

Phone

(347) 401-1399

Specialties & licenses 3

Addresses

Locations

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

• Ashley Chanell Harris

  • Clinical Social Worker
  • Waterbury, CT
  • NPI 1386207652
  NPD (past)
• Lauren Marie McTeague, APRN

  • Nurse Practitioner
  • Worcester, MA
  • NPI 1235205683
  NPD (past)

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549411200000",
    "number": "1396218293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WASHINGTON ST STE 552",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 CENTER ST FL 3",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022129",
            "telephone_number": "203-518-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYBLOCK MEDICAL PRACTICE CT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-02-06",
        "status": "A",
        "authorized_official_last_name": "ITSKOV",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "347-401-1399",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Zarrella Cipriani, AGPCNP-BC
• Tracey Ciriello, DPT
• Macaela Cirish, APRN
• City of Waterbury Board of Education
• City of Waterbury Health Department
• Kim M Clabbers, MD
• Clarity Eye Care LLC
• Kathleen A Clark
• Orinthia Clarke
• Amanda Clavette, LCSW

• All providers in Waterbury, CT
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.