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General NPI Number Information
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NPI Number | 1336958081
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Entity Type | Individual
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Provider Name | JOSHUA BACK PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 203-576-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1372 RIDGE RD
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3066
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Country | US
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Telephone | 203-927-8675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23.006961
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License Number State | CT
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