NISAR KHAN (Credential# 1510850) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2018. The license expiration date date is June 30, 2021. The license status is ACTIVE.
NISAR KHAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.060530-RES. The credential type is resident physician. The effective date is July 1, 2018. The expiration date is June 30, 2021. The business address is 130 Division St, Derby, CT 06418. The current status is active.
| Licensee Name | NISAR KHAN |
| Credential ID | 1510850 |
| Credential Number | 1.060530-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
130 Division St Derby CT 06418 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-07-01 |
| Effective Date | 2018-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2018-05-16 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1519313 | CSP.0068497 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-05-31 | 2019-03-22 - 2021-02-28 | ACTIVE |
| Street Address | 130 Division ST |
| City | Derby |
| State | CT |
| Zip Code | 06418 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ricardo Concepcion Gomez | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Anwesh Poosala | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Da Young Ryu | 130 Division St, Derby, CT 06418 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Genevieve C Kela | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Inshiya Dawoodi | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Sovit Dahal | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Rosa Constantino | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Ivanshi Gondalia | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Angad Gill | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Douglas Palacios | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Debra A Montini | 8 Academy Hill Ext, Derby, CT 06418 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Laura M Boanno | 131 Marshall La, Derby, CT 06418 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Danyun Chen | 49 Pershing Dr., Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Fan Geng | Shoprite Shopping Center, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Danni Xu | Shoprite Shopping Center49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Yao Zhang | Shoprite Shopping Center 49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Phillip N Burke | 3 Camptown St, Derby, CT 06418 | Emergency Medical Technician | 2017-06-07 ~ 2020-06-30 |
| Diane A Rosner | 229 Shagbark Drive, Derby, CT 06418 | Professional Counselor | 2020-08-01 ~ 2021-07-31 |
| Pamela C Lavelle | 194 Minerva St, Derby, CT 06418 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Grade A Market - Derby LLC | 49 Pershing Dr, Derby, CT 06418 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06418 | |||
| City | Derby |
| Zip Code | 06418 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + Derby |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Aisha Khan | 130 Division St, Derby, CT 06418 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Nasir Khan | 20 York St., New Haven, CT 06510-3220 | Resident Physician | 2016-06-27 ~ 2020-06-30 |
| Shehryar Khan | 165 Park St Apt 6, New Haven, CT 06515 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Mustafa U Khan | 38 Volunteer Ln, Greenwich, CT 06830-5414 | Resident Physician | 2018-06-25 ~ 2021-06-28 |
| Muhammad Hamza Khan | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Mohammad Shehryar Khan | 20 York St, New Haven, CT 06510 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Tasleema Khan | 20 York Street, New Haven, CT 06510 | Resident Physician | 2018-07-01 ~ 2021-06-30 |
| Hamza Khan | 20 York Street, New Haven, CT 06450 | Resident Physician | 2018-07-01 ~ 2019-06-30 |
| Amir Khan | 360 State St Apt 2214, New Haven, CT 06510-3621 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Aga Khan De Castro | 80 Seymour St, Po Box 5037, Hartford, CT 06102-5037 | Resident Physician | 2018-07-01 ~ 2019-06-30 |
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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).