BRETT E FORTUNE
Controlled Substance Registration for Practitioner


Address: 1305 York Ave Fl 4, New York, NY 10021-5663

BRETT E FORTUNE (Credential# 1082783) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2017. The license expiration date date is February 28, 2019. The license status is LAPSED.

Business Overview

BRETT E FORTUNE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0053177. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2017. The expiration date is February 28, 2019. The business address is 1305 York Ave Fl 4, New York, NY 10021-5663. The current status is lapsed.

Basic Information

Licensee Name BRETT E FORTUNE
Credential ID 1082783
Credential Number CSP.0053177
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 1305 York Ave Fl 4
New York
NY 10021-5663
Business Type INDIVIDUAL
Status LAPSED
Active 1
Issue Date 2012-07-13
Effective Date 2017-03-01
Expiration Date 2019-02-28
Refresh Date 2019-03-06

Other licenses

ID Credential Code Credential Type Issue Term Status
1069403 1.051154 Physician/Surgeon 2012-07-02 2012-07-02 - 2017-06-30 PENDING

Office Location

Street Address 1305 YORK AVE FL 4
City NEW YORK
State NY
Zip Code 10021-5663

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Competitor

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City NEW YORK
Zip Code 10021
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW YORK

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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