EDWIN DOMINGUEZ (Credential# 1222825) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is December 2, 2019. The license expiration date date is December 31, 2020. The license status is ACTIVE.
EDWIN DOMINGUEZ is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.053400. The credential type is physician/surgeon. The effective date is December 2, 2019. The expiration date is December 31, 2020. The business address is 1729 Haight Ave, Bronx, NY 10461-1401. The current status is active.
| Licensee Name | EDWIN DOMINGUEZ |
| Credential ID | 1222825 |
| Credential Number | 1.053400 |
| Credential Type | Physician/Surgeon |
| Business Address |
1729 Haight Ave Bronx NY 10461-1401 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2014-08-02 |
| Effective Date | 2019-12-02 |
| Expiration Date | 2020-12-31 |
| Refresh Date | 2019-12-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1250588 | CSP.0058899 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-10-29 | 2017-03-01 - 2019-02-28 | LAPSED |
| Street Address | 1729 HAIGHT AVE |
| City | BRONX |
| State | NY |
| Zip Code | 10461-1401 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jae Hong Kim | 2119 Colonial Ave., Bronx, NY 10461 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Kristy M Marmorato | 1242 Rhinelander Ave, Bronx, NY 10461 | Radiographer | 2020-09-01 ~ 2021-08-31 |
| Peter M Frisolone | 2526 Maclay Avenue, Bronx, NY 10461 | Embalmer | 2020-08-01 ~ 2021-07-31 |
| Sherin Zaman | 2049 Saint Paul Ave, Bronx, NY 10461 | Physician Assistant | 2020-01-01 ~ 2020-12-31 |
| Johanna Berberena | 1138 Edison Avenue, Bronx, NY 10461 | Master's Level Social Worker | 2020-05-01 ~ 2021-04-30 |
| Ellie E Martinez | 2820 Middletown Rd, Bronx, NY 10461 | Master's Level Social Worker | 2020-04-01 ~ 2021-03-31 |
| Christopher Morea | 2964 Middletown Road, Bronx, NY 10461 | Tax Preparer/facilitator Permit | 2020-03-02 ~ 2022-03-31 |
| Rakesh Raju Mahali | 1150 Pelham Parkway S Apt # 3e, Bronx, NY 10461 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Yogangi Malhotra | 1400 Pelham Pkwy S, Bronx, NY 10461 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Juan Carlos Perez | 2863 Dudley Ave, Bronx, NY 10461 | Dental Hygienist | 2020-03-01 ~ 2021-02-28 |
| Find all Licenses in zip 10461 | |||
| City | BRONX |
| Zip Code | 10461 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + BRONX |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Heidi L Dominguez Kolek | 95 Apple Ridge, West Springfield, MA 01089 | Physician/surgeon | 1999-03-08 ~ 2000-02-29 |
| Edwin Oh | 241 Hamilton Ave, Greenwich, CT 06830 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Edwin Raffi | 339 Massachusetts Ave, Arlington, MA 02474-6718 | Physician/surgeon | ~ |
| Edwin A Spath Jr | 859 Prospect Ave, W Hartford, CT 06105-4229 | Physician/surgeon | 2013-06-01 ~ 2014-05-31 |
| Edwin D Lacuanan | 3 Demartino Ave, Yonkers, NY 10703 | Physician/surgeon | 1996-08-05 ~ 1997-07-31 |
| Edwin W Lojeski Do | 310 Dakota Rd, Hailey, ID 83333 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Edwin D Williamson Md | 88 Cottage St Apt 1, New Haven, CT 06511-2404 | Physician/surgeon | 2010-04-01 ~ 2011-03-31 |
| Edwin V Tan | 720 West 170th St, New York, NY 10032 | Physician/surgeon | 1996-02-26 ~ 1997-02-28 |
| Edwin Tower Layng | 307 S Evergreen Ave, Woodbury, NJ 08096-2739 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Edwin H Dombrowski Md | Po Box 4201, Surf City, NC 28445 | Physician/surgeon | 1997-03-12 ~ 1998-04-30 |
Please comment or provide details below to improve the information on EDWIN DOMINGUEZ.
| 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).