SUZANNE MALLOUK MD (Credential# 560819) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2012. The license expiration date date is September 30, 2013. The license status is INACTIVE.
SUZANNE MALLOUK MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.043237. The credential type is physician/surgeon. The effective date is October 1, 2012. The expiration date is September 30, 2013. The business address is 544 Riverside Ave, Westport, CT 06880-5731. The current status is inactive.
| Licensee Name | SUZANNE MALLOUK MD |
| Credential ID | 560819 |
| Credential Number | 1.043237 |
| Credential Type | Physician/Surgeon |
| Business Address |
544 Riverside Ave Westport CT 06880-5731 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2005-03-24 |
| Effective Date | 2012-10-01 |
| Expiration Date | 2013-09-30 |
| Refresh Date | 2014-01-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 401079 | CSP.0037292 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2005-04-14 | 2011-03-01 - 2013-02-28 | INACTIVE |
| Street Address | 544 RIVERSIDE AVE |
| City | WESTPORT |
| State | CT |
| Zip Code | 06880-5731 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ruspini Realty LLC | 544 Riverside Ave, Westport, CT 06880 | Real Estate Broker | 2020-04-01 ~ 2021-03-31 |
| Barry Kerner | 544 Riverside Ave, Westport, CT 06880-5731 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Karen A Shannon | 544 Riverside Ave, Westport, CT 06880-5731 | Acupuncturist | 2018-12-01 ~ 2020-11-30 |
| Dominick J Romano Jr | 544 Riverside Ave, Westport, CT 06880 | Notary Public Appointment | 1958-12-01 ~ 1963-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Toni L Bucker | 4 Wild Rose Rd, Westport, CT 06880 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Jee Hyun Kim | 1 Allen Lane, Westport, CT 06880 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2021-07-31 |
| Donna Vaccarella | 15 Keyser Rd, Westport, CT 06880 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Sandra Gibson | 12 Bayberry Ln, Westport, CT 06880 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Adil Salam Md | 44 Crawford Rd, Westport, CT 06880 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Joanne C Sosnoski | 24 Hawatha Lane, Westport, CT 06880 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Rachel Lynn | 495 Post Rd East, Westport, CT 06880 | Eyelash Technician | ~ |
| Beginnings: An Infant/toddler Program | 71 Hillandale Road, Westport, CT 06880 | Group Child Care Home | 2018-01-01 ~ 2021-12-31 |
| Shelley S Ross | 28 Old Hill Farms Rd, Westport, CT 06880 | Dietitian/nutritionist | 2020-08-01 ~ 2021-07-31 |
| Robert W Van Summern | 279 Wilton Rd, Westport, CT 06880 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06880 | |||
| City | WESTPORT |
| Zip Code | 06880 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WESTPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Suzanne Marie Loiselle | 116 E 66th St Ste 1c, New York, NY 10065-6547 | Physician/surgeon | ~ |
| Suzanne T Jorey Md | 197 Kent Ave, Suffield, CT 06078 | Physician/surgeon | 2004-01-28 ~ 2005-02-28 |
| Suzanne Lei Aquino | Po Box 1619, Coeur D Alene, ID 83816-1619 | Physician/surgeon | ~ |
| Suzanne J Klekotka | 155 Montauk Ave, New London, CT 06320 | Physician/surgeon | 2019-08-01 ~ 2020-07-31 |
| Suzanne M Carroll Md | 11 S Brainard St, Naperville, IL 60540-4901 | Physician/surgeon | 2015-02-01 ~ 2016-01-31 |
| Suzanne P Tingley | 154 Main St, Old Saybrook, CT 06475 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Suzanne G Frisch | 131 Mill Stone Dr, Guilford, CT 06437 | Physician/surgeon | 2013-06-01 ~ 2014-05-31 |
| Suzanne Y Homer Md | 510 23rd St, Manhattan Beach, CA 90266-2205 | Physician/surgeon | 2015-08-01 ~ 2016-07-31 |
| Suzanne M Sgroi | 10 N Main St Ste 315, West Hartford, CT 06107-1901 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Suzanne Kohout Eschenbach | 30 Walnut Ave., Millburn, NJ 07041 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Please comment or provide details below to improve the information on SUZANNE MALLOUK 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).