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General NPI Number Information
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NPI Number | 1710098645
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 55 WALLS DR STE 405
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City | FAIRFIELD
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State | CT
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Zip | 06824-5163
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Country | US
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Telephone | 203-259-7070
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Fax | 203-254-7402
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Provider Business Mailing Address
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Address Line | 55 WALLS DR SUITE 405
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City | FAIRFIELD
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State | CT
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Zip | 06824-5163
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Country | US
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Telephone | 203-259-7070
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Fax | 203-254-7402
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH S. BACKMAN
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Credential | M.D.
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Telephone | 203-259-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 038854
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License Number State | CT
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