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BACK TO HEALTH OF BRANFORD LLC NPI 1215958772


NPI Information

NPI: 1215958772
Provider Name: BACK TO HEALTH OF BRANFORD, LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 07D1072612

Address:
400 WEST MAIN STREET
BRANFORD, CT
ZIP 06405
Phone: (203) 483-7778
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BACK TO HEALTH OF BRANFORD, LLC is an internal medicine in Branford, CT. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. BACK TO HEALTH OF BRANFORD, LLC NPI is 1215958772. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

400 WEST MAIN STREET
BRANFORD, CT
ZIP 06405
Phone: (203) 483-7778
Fax: (203) 481-0234

The provider's authorized official is Sharon L Bailey .
The authorized official title is Office Administrator and has the following contact phone number (203) 483-7778.

The CLIA number assigned to this NPI record is 07D1072612 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/21/2006 and was last updated on 12/22/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111NI0900XChiropractorInternist000561CONNECTICUTNo
2111N00000XChiropractor148CONNECTICUTNo
3363LF0000XNurse PractitionerFamily002765CONNECTICUTNo
4111N00000XChiropractor001614CONNECTICUTNo
5335E00000XProsthetic/Orthotic Supplier037255CONNECTICUTNo
6332B00000XDurable Medical Equipment & Medical Supplies037255CONNECTICUTNo
7207R00000XInternal Medicine037255CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C02868OTHERGROUP
2008038901MEDICAIDCONNECTICUT
3250000377MEDICARE PIN
4G93443MEDICARE UPIN
5S72173MEDICARE UPIN
66696760001MEDICARE NSCCONNECTICUT
7G93443MEDICARE UPINCONNECTICUT
807D1072612OTHERCONNECTICUTCLIA WAIVER
9U18188MEDICARE UPIN
10008038939MEDICAIDCONNECTICUT
11350001195MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.