EDWIN JIN SU LEE (Credential# 1440768) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is August 11, 2017. The license expiration date date is February 28, 2019. The license status is LAPSED.
EDWIN JIN SU LEE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0066496. The credential type is controlled substance registration for practitioner. The effective date is August 11, 2017. The expiration date is February 28, 2019. The business address is 297 Grant St, Bridgeport, CT 06610-2805. The current status is lapsed.
| Licensee Name | EDWIN JIN SU LEE |
| Credential ID | 1440768 |
| Credential Number | CSP.0066496 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
297 Grant St Bridgeport CT 06610-2805 |
| Business Type | INDIVIDUAL |
| Status | LAPSED |
| Active | 1 |
| Issue Date | 2017-08-11 |
| Effective Date | 2017-08-11 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1433807 | 1.056862 | Physician/Surgeon | 2017-08-10 | 2018-02-01 - 2019-01-31 | INACTIVE |
| 1489272 | 1.058511-RES | Resident Physician | 2017-07-01 | 2017-07-01 - 2018-06-30 | INACTIVE |
| Street Address | 297 GRANT ST |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06610-2805 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lauren Roth | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2024-06-30 |
| Gilead I Lancaster Md | 267 Grant St Fl 10, Bridgeport, CT 06610-2805 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Nabil A Atweh | 267 Grant St Fl 8, Bridgeport, CT 06610-2805 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Wilhelmina Jackson | 226 Mill Hill Ave., Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Joanna Zolkowski-wynne | 267 Grant St # 5000, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mohammad A Younus | 287 Grant St, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Madeline Carmain | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-06-22 ~ 2024-06-30 |
| Aishwariya S Vegunta | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Rasha T Ismail | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Mark Steven Mcfarland | 267 Grant St, Bridgeport, CT 06610-2805 | Resident Physician | 2018-07-01 ~ 2023-06-30 |
| Find all Licenses in zip 06610-2805 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nilca Janice Cardenales | 66 Rose St, Bridgeport, CT 06610 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Kiara Lizbeth Corporan | 10 Sturtevant Pl, Bridgeport, CT 06610 | Eyelash Technician | ~ |
| Alisha Garcia | 65 Berkeley Place, Bridgeport, CT 06610 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Pauline Parkes | 96 Virginia Avenue, Bridgeport, CT 06610 | Licensed Clinical Social Worker | ~ |
| Denise Reyes | 1125 Huntington Turnpike, Bridgeport, CT 06610 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Avery M Rilley | 80 Granfield Avenue, Bridgeport, CT 06610 | Pharmacy Technician | 2020-06-25 ~ 2021-03-31 |
| Bozena K. Malyszko | Bridgeport Hospital, Bridgeport, CT 06610 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Amy Espinosa | 146 Court D, Bridgeport, CT 06610 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Wilhelmina Jackson · Thomas | 172 Court D, Bridgeport, CT 06610 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Emma Agyeiwaa Vaczek | P.o Box 5223, Bridgeport, CT 06610 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06610 | |||
| City | BRIDGEPORT |
| Zip Code | 06610 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + BRIDGEPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Edwin H Mulford II | Po Box 571, Chester, CT 06412 | Controlled Substance Registration for Practitioner | 1999-03-01 ~ 2000-02-28 |
| Edwin F Richter IIi | 166 W Broad St Ste 305, Stamford, CT 06902-3661 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Edwin Czovek | 318 Westwood Rd, Bristol, CT 06010-8953 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Edwin A Lomotan Md | 5 Devon Ct, Rockville, MD 20850 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| C Edwin Carlson Md | 129 Mill St, Berlin, CT 06037 | Controlled Substance Registration for Practitioner | ~ |
| Edwin R Cook Dds | 75 Sturbridge Rd, Easton, CT 06612-2030 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Edwin A Spath Jr | 1000 Asylum Ave, Hartford, CT 06105 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Edwin A Njoku Md | 587 Burnside Ave, East Hartford, CT 06108-3537 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Edwin K Chung Md | 64-26 232 Street, Oakland Gardens, NY 11364 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Edwin Alexander Anders | 130 Division St, Derby, CT 06418 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on EDWIN JIN SU LEE.
| 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).