PHILLIP JACOB MD (Credential# 164272) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is February 29, 2004. The license expiration date date is February 28, 2005. The license status is INACTIVE.
PHILLIP JACOB MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0022236. The credential type is controlled substance registration for practitioner. The effective date is February 29, 2004. The expiration date is February 28, 2005. The business address is 106 Turnpike Road, Somers, CT 06071. The current status is inactive.
| Licensee Name | PHILLIP JACOB MD |
| Credential ID | 164272 |
| Credential Number | CSP.0022236 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
106 Turnpike Road Somers CT 06071 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - SURRENDERED |
| Effective Date | 2004-02-29 |
| Expiration Date | 2005-02-28 |
| Refresh Date | 2004-04-23 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 551357 | 1.033758 | Physician/Surgeon | 1994-05-27 | 2003-07-09 - 2004-08-31 | INACTIVE |
| Street Address | 106 TURNPIKE ROAD |
| City | SOMERS |
| State | CT |
| Zip Code | 06071 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rebecca's Country Pie | 35 Pinedale Rd, Somers, CT 06071 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Joseph P Grzelak | 36 Pond Circle, Somers, CT 06071 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Susan P Haight | 51 Whisper Woods Drive, Somers, CT 06071 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Alison Poppe | 121 Florida Rd, Somers, CT 06071 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Emily Pruden | 100 Bobolink Ln, Somers, CT 06071 | Registered Nurse | 2020-06-17 ~ 2020-11-30 |
| Matthew D Higgins | 10 Whisper Woods Drive, Somers, CT 06071 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Judith C Napolitano | 55 White Birch Circle, Somers, CT 06071 | Real Estate Salesperson | ~ |
| Mary Ellen Bickley | 552 Springfield Rd, Somers, CT 06071 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| J C Real Estate Group LLC | 3 School St, Somers, CT 06071 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| Laurie A Mahon · Wirtalla | 531 Hallhill Rd, Somers, CT 06071 | Hairdresser/cosmetician | 2020-06-01 ~ 2022-05-31 |
| Find all Licenses in zip 06071 | |||
| City | SOMERS |
| Zip Code | 06071 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + SOMERS |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Phillip Brewer Md | 275 Mount Carmel Ave, Hamden, CT 06518-1905 | Controlled Substance Registration for Practitioner | 2013-04-19 ~ 2015-02-28 |
| Gabrielle Phillip | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip Joseph | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-05-16 ~ 2021-02-28 |
| Phillip Chappell | 153 Elm Street, Guilford, CT 06437 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip A Brewer | 3 Dover Court, Cheshire, CT 06410 | Controlled Substance Registration for Practitioner | 2019-05-17 ~ 2021-02-28 |
| Phillip Nickerson | 109 Church St Unit 204, New Haven, CT 06510-3025 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip Kohanski Md | 289 New London Tpke, Norwich, CT 06360 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Danielle S Phillip-journal | 132 Main St, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip B Goldblatt Md | 79 Trumbull Street, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Phillip J Lerner | 151 Farmington Avenue, Hartford, CT 06156 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on PHILLIP JACOB MD.
| 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).