Provider Demographics
NPI:1528055266
Name:BACK, NORMAN A (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:A
Last Name:BACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 IRON BRIDGE ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-431-1807
Mailing Address - Fax:732-409-2777
Practice Address - Street 1:501 IRON BRIDGE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-431-1807
Practice Address - Fax:732-409-2777
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04582700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K6859OtherHEALTHNET
MP029OtherOXFORD
0036784OtherGHI
0098317000OtherAMERIHEALTH
MP029OtherOXFORD
458306Medicare ID - Type Unspecified