JULIO BALLESTAS (Credential# 1286369) 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.
JULIO BALLESTAS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0060287. 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 220 Fort Salonga Rd, Northport, NY 11768. The current status is lapsed.
Licensee Name | JULIO BALLESTAS |
Credential ID | 1286369 |
Credential Number | CSP.0060287 |
Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
Business Address |
220 Fort Salonga Rd Northport NY 11768 |
Business Type | INDIVIDUAL |
Status | LAPSED |
Active | 1 |
Issue Date | 2015-05-22 |
Effective Date | 2017-03-01 |
Expiration Date | 2019-02-28 |
Refresh Date | 2019-03-06 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
1269597 | 1.054124 | Physician/Surgeon | 2015-05-11 | 2017-06-01 - 2018-05-31 | INACTIVE |
Street Address | 220 Fort Salonga Rd |
City | Northport |
State | NY |
Zip Code | 11768 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Ryan L Kleinkopf | 21 Lorraine Court, Northport, NY 11768 | Emergency Medical Technician | ~ |
Michael A Memoli | 51 Heights Rd, Northport, NY 11768 | Professional Engineer | 2014-02-01 ~ 2015-01-31 |
Kenneth W Bossung | 88 Laurel Hill Road, Northport, NY 11768 | Professional Engineer | 2014-02-01 ~ 2015-01-31 |
Grace Brown | 19 Essex Drive, Northport, NY 11768 | Registered Nurse | 2020-03-01 ~ 2021-02-28 |
Margaret Clare Ward | 112 Lisa Drive, Northport, NY 11768 | Registered Nurse | 2020-02-01 ~ 2021-01-31 |
David J Mastanduno | 11 Winkle Point Dr, Northport, NY 11768 | Interior Designer | 2020-01-01 ~ 2020-12-31 |
John V Catapano | 46 Brookfield Road, Fort Salonga, NY 11768 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
Robert A Peterson | 22 Beverly Court, Northport, NY 11768 | Architect | 2019-08-01 ~ 2020-07-31 |
Tracy Margaret Thorn | 78 Mar-man Drive, Northport, NY 11768 | Registered Nurse | ~ |
Eric S Postal | 30 Allenby Drive, Northport, NY 11768 | Physician/surgeon | 2018-03-01 ~ 2019-02-28 |
Find all Licenses in zip 11768 |
City | Northport |
Zip Code | 11768 |
License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Northport |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Julio C. Defillo | 208 Wooster St Apt 3, New Haven, CT 06511-5792 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
Julio E Pena | 34 Barnett St Apt E1, New Haven, CT 06515-2059 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
Julio N Sepulveda | 66 Orange St Apt 316, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
Julio Nasim | 24 Hospital Ave. Apt 303-304, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Julio M Beras | 24 Hospital Ave, Danbury, CT 06810-6099 | Controlled Substance Registration for Practitioner | 2013-03-07 ~ 2015-02-28 |
Julio R Duran | 273 Broad Brook Rd, Enfield, CT 06082 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Julio E Chinchilla Md | 152 Temple Street Apt 518, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | ~ |
Julio Alberto Riascos | 2655 Northwinds Pkwy, Alpharetta, GA 30009-2280 | Controlled Substance Registration for Practitioner | 2019-03-11 ~ 2021-02-28 |
Julio Alvarenga Thiebaud | 1111 Stratford Ave Apt 421, Stratford, CT 06615-6372 | Controlled Substance Registration for Practitioner | 2016-10-26 ~ 2017-06-30 |
Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
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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).