Provider Demographics
NPI:1487087250
Name:QUENTIN MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:QUENTIN MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-333-4400
Mailing Address - Street 1:161 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1662
Mailing Address - Country:US
Mailing Address - Phone:203-333-4400
Mailing Address - Fax:
Practice Address - Street 1:161 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1662
Practice Address - Country:US
Practice Address - Phone:203-333-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038137261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care