Healthcare Provider Details

I. General information

NPI: 1023471299
Provider Name (Legal Business Name): QMG4, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MAIN STREET
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

4200 MAIN STREET
BRIDGEPORT CT
06606
US

V. Phone/Fax

Practice location:
  • Phone: 203-916-5151
  • Fax: 203-916-5155
Mailing address:
  • Phone: 203-916-5151
  • Fax: 203-916-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: STEVEN MARTIN HEFFER
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 203-916-5151