Provider Demographics
NPI:1710098645
Name:ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CARE OF FAIRFIELD COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-259-7070
Mailing Address - Street 1:55 WALLS DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5163
Mailing Address - Country:US
Mailing Address - Phone:203-259-7070
Mailing Address - Fax:203-254-7402
Practice Address - Street 1:55 WALLS DR
Practice Address - Street 2:STE 405
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5163
Practice Address - Country:US
Practice Address - Phone:203-259-7070
Practice Address - Fax:203-254-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038854207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT038854OtherCONNECTICARE
CT1439465OtherUNITED HEALTHCARE
CTP861731OtherOXFORD
CT010038854CT02OtherANTHEM
CT7914842006OtherCIGNA
CT0V8243OtherHEALTHNET
CT7914842006OtherCIGNA
CT038854OtherCONNECTICARE