SELENE K BANTZ (Credential# 1083493) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
SELENE K BANTZ is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.051238. The credential type is physician/surgeon. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 320 Jackson Road, Medford, NJ 08055. The current status is active.
| Licensee Name | SELENE K BANTZ |
| Credential ID | 1083493 |
| Credential Number | 1.051238 |
| Credential Type | Physician/Surgeon |
| Business Address |
320 Jackson Road Medford NJ 08055 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2012-07-25 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-02-10 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1085376 | CSP.0053342 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2012-08-20 | 2020-02-09 - 2021-02-28 | ACTIVE |
| Street Address | 320 Jackson Road |
| City | Medford |
| State | NJ |
| Zip Code | 08055 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jennifer Amy Prescott-coraggio | 15 Wellesley Way, Medford, NJ 08055 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Sung K Ro | 9 Somerton Square, Medford, NJ 08055 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| William J Porter · Allstate Conveyor Service Inc | 40 S. Lakeside Dr. W., Medford, NJ 08055 | Elevator Limited Conveyor Contractor | 2019-09-01 ~ 2020-08-31 |
| Daniel F O'brien | 8 Enclave Court, Medford, NJ 08055 | Resident Physician | 2016-07-01 ~ 2021-06-30 |
| Lina Marcela Velez | 2 Dakota Trail, Medford, NJ 08055 | Registered Nurse - Temporary | 2016-08-29 ~ 2016-12-26 |
| James P Scott | 36 Cranberry Ct, Medford, NJ 08055 | Professional Engineer | 1993-01-25 ~ 1994-01-31 |
| Bryan H Atkinson | 1 Eden Circle Rd, Medford, NJ 08055 | Professional Engineer | 2005-02-01 ~ 2006-01-31 |
| Mary F Etter | 15 Elderberry Drive, Medford, NJ 08055 | Registered Nurse | 2014-07-01 ~ 2015-06-30 |
| Stephen E Pilch | 92 Manhasset Trail, Medford Lakes, NJ 08055 | Radiographer | 2013-05-01 ~ 2014-04-30 |
| Patricia A Gregg | 104 Pine Valley Dr, Medford, NJ 08055 | Registered Nurse | 2013-03-01 ~ 2014-02-28 |
| Find all Licenses in zip 08055 | |||
| City | Medford |
| Zip Code | 08055 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Medford |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Victory Selene Saison | Conecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2016-06-24 ~ 2019-06-23 |
| Selene Napa Valley Merlot | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2015-03-04 ~ 2018-03-02 |
| Selene Napa Valley Red Chesler | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2015-03-04 ~ 2018-03-02 |
| Selene Napa Valley Cabenet Sauvignon | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2009-03-06 ~ 2012-03-04 |
| Selene Sauvignon Blanc Hyde Vineyard | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2018-03-03 ~ 2021-03-01 |
| Selene Cabernet Sauvignon Dead Fred Vineyard | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2011-04-19 ~ 2014-04-18 |
| Andrea K Bantz | 126 W 2nd St, Hartford, IL 62048-1204 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| John E Bantz | 22 Bates St, Abington, MA 02351-1709 | Sub-surface Sewage Cleaner | 2015-09-01 ~ 2016-08-31 |
| Katherine Bantz | 142 Rosemere Avenue, Fairfield, CT 06430 | Notary Public Appointment | 1989-09-20 ~ 1994-03-31 |
| Marilyn G Bantz · Blue Spruce Painting | 34 Tyler Farms Rd, Plainville, CT 06062-1184 | Home Improvement Contractor | 2019-12-01 ~ 2020-11-30 |
Please comment or provide details below to improve the information on SELENE K BANTZ.
| 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).