ELYSE GOLDBLUM (Credential# 1284248) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
ELYSE GOLDBLUM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0060224. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 4 Hospital Plaza, Stamford, CT 06902. The current status is active.
| Licensee Name | ELYSE GOLDBLUM |
| Credential ID | 1284248 |
| Credential Number | CSP.0060224 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
4 Hospital Plaza Stamford CT 06902 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2015-05-19 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-02-19 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1267601 | 1.053996 | Physician/Surgeon | 2015-04-16 | 2019-12-01 - 2020-11-30 | ACTIVE |
| Street Address | 4 HOSPITAL PLAZA |
| City | STAMFORD |
| State | CT |
| Zip Code | 06902 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ronald A Giannotto | 4 Hospital Plaza, Stamford, CT 06902 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Devon Jeffers | 4 Hospital Plaza, Stamford, CT 06902 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Ayse Fidan Genc | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-07 ~ 2021-02-28 |
| Maria Mazzeo | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Shayna Zachary | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Tara M Doherty | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Ron Giannotto Md | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Betty Ann Robustelli Md | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Steven A Finkel Md | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Shahid Rafiq | 4 Hospital Plaza, Stamford, CT 06902 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jeris Maydeli Flores | 153 Fairfield Av, Stamford, CT 06902 | Nail Technician | ~ |
| Reynaldo De La Cruz | 64 Brookside Drive, Stamford, CT 06902 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Darren J Petillo | 5 Hundley Court, Stamford, CT 06902 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Antonios Restaurant | 405 West Main St, Stamford, CT 06902 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Edward Smith | 184 Fairfield Ave., Stamford, CT 06902 | Home Improvement Contractor | ~ |
| Margaret A Dorrance | 24c Hamilton Court, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carolyn Maguire | 48 Nelson St, Stamford, CT 06902 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Evelyne Joassin | 17 George St., Stamford, CT 06902 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Andrea Bynoe | 34 Melrose Pl, Stamford, CT 06902 | Notary Public Appointment | 1994-04-06 ~ 1999-04-30 |
| Ravi K Ahuja | 296 Westover Rd, Stamford, CT 06902 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06902 | |||
| City | STAMFORD |
| Zip Code | 06902 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + STAMFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elyse Fults | 20 York St Rm 226, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-06-05 ~ 2021-02-28 |
| Elyse N Sudhoff | 56 Curtis Rd, Glastonbury, CT 06033-3203 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Rachel Elyse Katz | 70 Danbury Rd, Wilton, CT 06897 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Elyse G Stock Md | 61 Old Quarry Road, Woodbridge, CT 06525 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Elyse G Seltzer | 94 Cherry Hill Road, Branford, CT 06405 | Controlled Substance Registration for Practitioner | 1997-03-01 ~ 1998-02-28 |
| Alex Goldblum Development Co Inc. | Po Box 110422, Stamford, CT 06911 | Demolition Contractor | 2016-01-01 ~ 2016-12-31 |
| Steven Kassels Md · Community Substance Abuse Center | Comm. Physicians PC/125 North Elm Street, Westfield, MA 01085 | Controlled Substance Registration for Practitioner | 2018-06-15 ~ 2019-02-28 |
| Shu-i Lin | CT | Controlled Substance Registration for Practitioner | 2017-06-12 ~ 2019-02-28 |
| Qi Che Md | Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
| Min Jin Kim | 639 4th Ave Apt 5c, Brooklyn, NY 11232-1048 | Controlled Substance Registration for Practitioner | 2012-05-10 ~ 2013-02-28 |
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| 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).