JESEN C S FAN MD (Credential# 544856) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is February 20, 2001. The license expiration date date is April 30, 2002. The license status is INACTIVE.
JESEN C S FAN MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.024017. The credential type is physician/surgeon. The effective date is February 20, 2001. The expiration date is April 30, 2002. The business address is 49 Sanford Rd, Woodbury, CT 06798. The current status is inactive.
| Licensee Name | JESEN C S FAN MD |
| Credential ID | 544856 |
| Credential Number | 1.024017 |
| Credential Type | Physician/Surgeon |
| Business Address |
49 Sanford Rd Woodbury CT 06798 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1983-04-04 |
| Effective Date | 2001-02-20 |
| Expiration Date | 2002-04-30 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 153773 | CSP.0011858 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2001-03-01 - 2002-02-28 | INACTIVE |
| Street Address | 49 SANFORD RD |
| City | WOODBURY |
| State | CT |
| Zip Code | 06798 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Russell J Hardy | 229 Bacon Pond Rd #114, Woodbury, CT 06798 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Geoffrey S Middeleer | 20 Roxbury Road, Woodbury, CT 06798 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Elaine P Templeton | 197 Carmel Hill Road, Woodbury, CT 06798 | Real Estate Salesperson | ~ |
| Ayrica L Gelinas | 65 Laurel Woods Road, Woodbury, CT 06798 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Christopher R Laux | Grey Fox Trail, Woodbury, CT 06798 | Architect | 2020-08-01 ~ 2021-07-31 |
| Diane L Robinson | P O Box 208, Woodbury, CT 06798 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Scott Freitag | 47 Woodbury Hill, Woodbury, CT 06798 | Medication Administration Certification | ~ |
| Brenda L Lupo | 31 Blueberry Lane, Woodbury, CT 06798 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Jennifer L Thompson | 1280 Main St. North, Woodbury, CT 06798 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
| Eileen O Pflegl | 3 Hazel Plain Road, Woodbury, CT 06798 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Find all Licenses in zip 06798 | |||
| City | WOODBURY |
| Zip Code | 06798 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WOODBURY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth Lynne Fell | 824 Nw Waterlily Pl, Jesen Beach, FL 34957 | Registered Nurse | 2019-11-01 ~ 2020-10-31 |
| Jesen St Victor | 159 Rock Spring Rd, Stamford, CT 06906-1931 | Licensed Practical Nurse | 2020-01-07 ~ 2021-01-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
Please comment or provide details below to improve the information on JESEN C S FAN 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).