NPI 1336958081 · live from the CMS NPI Registry
Joshua Back, PA-C
Physician Assistant in Bridgeport, CT. National Provider Identifier 1336958081, active.
NPI record
| NPI | 1336958081 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 2800 Main St, Bridgeport, CT 06606 |
| Practice phone | 203-576-6000 |
| Mailing address | 1372 Ridge Rd, North Haven, CT 06473 |
| Enumerated | January 6, 2025 |
| Last updated | April 4, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | 23.006961 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.