ELLEN P ELLIS
Physician/surgeon


Address: 30 Park Ave, New York, NY 10016

ELLEN P ELLIS (Credential# 538000) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is December 20, 1991. The license expiration date date is December 31, 1992. The license status is INACTIVE.

Business Overview

ELLEN P ELLIS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.000253-DO. The credential type is physician/surgeon. The effective date is December 20, 1991. The expiration date is December 31, 1992. The business address is 30 Park Ave, New York, NY 10016. The current status is inactive.

Basic Information

Licensee Name ELLEN P ELLIS
Credential ID 538000
Credential Number 1.000253-DO
Credential Type Physician/Surgeon
Credential SubCategory DO
Business Address 30 Park Ave
New York
NY 10016
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1988-05-16
Effective Date 1991-12-20
Expiration Date 1992-12-31
Refresh Date 2009-07-08

Office Location

Street Address 30 PARK AVE
City NEW YORK
State NY
Zip Code 10016

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Daniel Gorman 145 E 27th Street, New York, NY 10016 Master's Level Social Worker - Temporary Permit 2020-06-16 ~ 2020-09-13
Steven Issley 545 First Avenue, Suite 6g, New York, NY 10016 Physician/surgeon 2020-07-01 ~ 2021-06-30
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Competitor

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City NEW YORK
Zip Code 10016
License Type Physician/Surgeon
License Type + County Physician/Surgeon + NEW YORK

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Dataset Information

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).

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