Provider Demographics
NPI:1730565979
Name:HARVEY, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NUTMEG DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5431
Mailing Address - Country:US
Mailing Address - Phone:617-599-8287
Mailing Address - Fax:
Practice Address - Street 1:35 NUTMEG DR
Practice Address - Street 2:SUITE 303
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5431
Practice Address - Country:US
Practice Address - Phone:617-599-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07D2090970291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory