Healthcare Provider Details

I. General information

NPI: 1841002300
Provider Name (Legal Business Name): MICHAEL BACKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CUMPSTONE DR
HAMDEN CT
06518-2423
US

IV. Provider business mailing address

22 CUMPSTONE DR
HAMDEN CT
06518-2423
US

V. Phone/Fax

Practice location:
  • Phone: 940-206-5033
  • Fax:
Mailing address:
  • Phone: 940-206-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16675
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.212557
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: