Provider Demographics
NPI:1043311038
Name:BACKOFEN, SCOTT H (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:BACKOFEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:12 E 46TH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2418
Mailing Address - Country:US
Mailing Address - Phone:212-499-0876
Mailing Address - Fax:212-953-1353
Practice Address - Street 1:17 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0302
Practice Address - Country:US
Practice Address - Phone:212-988-2501
Practice Address - Fax:212-988-2509
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
025593-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1779725OtherUNITED HEALTHCARE
NYN46882OtherHEALTH NET
P3613297OtherOXFORD HEALTH PLANS
P3613297OtherOXFORD HEALTH PLANS