Healthcare Provider Details

I. General information

NPI: 1376092007
Provider Name (Legal Business Name): QMG3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 BRIDGEPORT AVENUE
SHELTON CT
06484
US

IV. Provider business mailing address

405 BRIDGEPORT AVENUE
SHELTON CT
06484
US

V. Phone/Fax

Practice location:
  • Phone: 203-567-4171
  • Fax: 203-567-4172
Mailing address:
  • Phone: 203-567-4171
  • Fax: 203-567-4172

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: M.D.
Phone: 203-583-8400