EDWARD JOHN DETWEILER (Credential# 1514260) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2018. The license expiration date date is June 30, 2021. The license status is ACTIVE.
EDWARD JOHN DETWEILER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.060884-RES. The credential type is resident physician. The effective date is July 1, 2018. The expiration date is June 30, 2021. The business address is 476 Roy St, West Hempstead, NY 11552-2228. The current status is active.
| Licensee Name | EDWARD JOHN DETWEILER |
| Credential ID | 1514260 |
| Credential Number | 1.060884-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
476 Roy St West Hempstead NY 11552-2228 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-07-01 |
| Effective Date | 2018-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2018-05-16 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1501161 | CSP.0067672 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-05-16 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 476 ROY ST |
| City | WEST HEMPSTEAD |
| State | NY |
| Zip Code | 11552-2228 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marie I Gracia-pierre | 240 Guildford Court, West Hempstead, NY 11552 | Master's Level Social Worker | 2020-05-01 ~ 2021-04-30 |
| Roger E Ravix | 655 Nightingale Road, West Hempstead, NY 11552 | Licensed Practical Nurse | 2020-01-01 ~ 2020-12-31 |
| Keri Mc Namara | 125 Hempstead Gardens Drive M2d, West Hempstead, NY 11552 | Notary Public Appointment | 2016-06-29 ~ 2021-06-30 |
| Tamir Aldad | 510 Hempstead Tpk, West Hempstead, NY 11552 | Physician/surgeon | 2019-09-03 ~ 2020-09-30 |
| Chiemika Alozie | 956 Derrick Adkins Lane, West Hempstead, NY 11552 | Master's Level Social Worker | 2019-09-01 ~ 2020-08-31 |
| Eliezer Halpert | 256 Windsor Ln, West Hempsted, NY 11552 | Controlled Substance Registration for Practitioner | 2019-02-15 ~ 2021-02-28 |
| Rose Laure Valme | 354 Hempstead Ave, West Hempstead, NY 11552 | Registered Nurse | 2018-02-16 ~ 2018-07-31 |
| Evangeline S Molina | 235 Walton Street, West Hempstead, NY 11552 | Registered Nurse | 2017-06-01 ~ 2018-05-31 |
| Nick Associated Inc | 88 Mayfair Ave, West Hempstead, NY 11552 | Home Improvement Contractor | 2000-12-01 ~ 2001-11-30 |
| Wholesale Remodelers Inc | 333 Hempstead Tpke, West Hempstead, NY 11552 | Home Improvement Contractor | 2000-12-19 ~ 2001-11-30 |
| Find all Licenses in zip 11552 | |||
| City | WEST HEMPSTEAD |
| Zip Code | 11552 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + WEST HEMPSTEAD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Edward Lee | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-06-24 ~ 2021-06-30 |
| Edward Manning | 102 Seymour Rd, Woodbridge, CT 06525 | Resident Physician | 2016-07-01 ~ 2021-06-30 |
| Edward Gillis | 35 Prospect Ave, Lynbrook, NY 11563-3931 | Resident Physician | 2017-07-01 ~ 2021-06-30 |
| Alex Edward Blanchette | 20 York St Rm 226, New Haven, CT 06510-3220 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Alexander Edward Frey | 305 George St Apt 3b, New Haven, CT 06511-6681 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Edward P St John · Edward St John Construction | 57 Candle Hill Rd, New Fairfield, CT 06812 | Home Improvement Contractor | 2002-03-06 ~ 2002-11-30 |
| Edward Michael Zitnik | 20 York Street, New Haven, CT 06511 | Resident Physician | 2020-01-06 ~ 2021-01-31 |
| Edward Victor Singh | 301 Commons Park South Unit 502, Stamford, CT 06902 | Resident Physician | 2019-07-22 ~ 2021-06-30 |
| John T Creegan | 267 Lincoln Pl Apt 4a, Brooklyn, NY 11238-5704 | Resident Physician | 2017-06-28 ~ 2021-06-30 |
| John B Fournier | 20 York St, New Haven, CT 06510 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
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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).