Provider Demographics
NPI:1568417426
Name:BACK TO HEALTH MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:BACK TO HEALTH MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-381-9703
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-0617
Mailing Address - Country:US
Mailing Address - Phone:203-381-9703
Mailing Address - Fax:203-381-9802
Practice Address - Street 1:3355 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4845
Practice Address - Country:US
Practice Address - Phone:203-381-9703
Practice Address - Fax:203-381-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010031532CT01OtherANTHEM BLUE CROSS
CTP2185176OtherOXFORD
CTCV2485OtherACS HEALTHNET