Healthcare Provider Details

I. General information

NPI: 1407719339
Provider Name (Legal Business Name): CITYBLOCK IPA NY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 BEDFORD AVE
BROOKLYN NY
11216-1813
US

IV. Provider business mailing address

495 FLATBUSH AVE
BROOKLYN NY
11225-3706
US

V. Phone/Fax

Practice location:
  • Phone: 833-904-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OLUWATOYIN AJAYI
Title or Position: CEO, CITYBLOCK HEALTH, INC.
Credential: MD
Phone: 347-463-5529