MS. SARA DEBORAH BACK FNP MPH NPI 1104811991

NPI Information

  • NPI: 1104811991
  • Provider Name: MS. SARA DEBORAH BACK, FNP MPH
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3424 KOSSUTH AVE
    RM #3H17
    BRONX, NY
    ZIP 10467
  • Phone: (718) 519-3631

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NPI Details

MS. Sara Deborah Back, FNP MPH is a family nurse practitioner in Bronx, NY. MS. Sara Deborah Back, FNP MPH NPI is 1104811991. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3424 KOSSUTH AVE
RM #3H17
BRONX, NY
ZIP 10467-410
Phone: (718) 519-3631
Fax: (718) 519-2034

The NPI 1104811991 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/17/2005 and was last updated on 7/9/2008.

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
1363LF0000XNurse PractitionerFamilyF333271NEW YORKYes

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
102108950MEDICAIDNEW YORK

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: 11/21/2025

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