EDISON R BLANCO
Physician/surgeon


Address: 147-20 35th Ave 10f, Flushing, NY 11354

EDISON R BLANCO (Credential# 549653) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 12, 1995. The license expiration date date is August 31, 1996. The license status is INACTIVE.

Business Overview

EDISON R BLANCO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.031999. The credential type is physician/surgeon. The effective date is June 12, 1995. The expiration date is August 31, 1996. The business address is 147-20 35th Ave 10f, Flushing, NY 11354. The current status is inactive.

Basic Information

Licensee Name EDISON R BLANCO
Credential ID 549653
Credential Number 1.031999
Credential Type Physician/Surgeon
Business Address 147-20 35th Ave 10f
Flushing
NY 11354
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1991-11-22
Effective Date 1995-06-12
Expiration Date 1996-08-31
Refresh Date 2009-07-08

Office Location

Street Address 147-20 35TH AVE 10F
City FLUSHING
State NY
Zip Code 11354

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City FLUSHING
Zip Code 11354
License Type Physician/Surgeon
License Type + County Physician/Surgeon + FLUSHING

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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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