Provider Demographics
NPI:1043457245
Name:THE PERSONALIZED MEDICINE GROUP OF CONNECTICUT
Entity type:Organization
Organization Name:THE PERSONALIZED MEDICINE GROUP OF CONNECTICUT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-617-0742
Mailing Address - Street 1:2015 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4536
Mailing Address - Country:US
Mailing Address - Phone:203-617-0742
Mailing Address - Fax:212-918-9394
Practice Address - Street 1:2015 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4536
Practice Address - Country:US
Practice Address - Phone:203-617-0742
Practice Address - Fax:212-918-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044806207R00000X
CT046225207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty