LEROY NICKLES, JR (Credential# 1595168) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
LEROY NICKLES, JR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.062001. The credential type is physician/surgeon. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 64 Robbins St, Waterbury, CT 06708-2613. The current status is active.
| Licensee Name | LEROY NICKLES, JR |
| Credential ID | 1595168 |
| Credential Number | 1.062001 |
| Credential Type | Physician/Surgeon |
| Business Address |
64 Robbins St Waterbury CT 06708-2613 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-10-02 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-03-20 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1606280 | CSP.0069687 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-10-09 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 64 ROBBINS ST |
| City | WATERBURY |
| State | CT |
| Zip Code | 06708-2613 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Emery A Edmondson | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2020-06-28 ~ 2025-06-27 |
| Neville M Patel | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2020-06-28 ~ 2025-06-27 |
| Gaspar A Barreto Montero | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-28 ~ 2024-06-27 |
| Michael T. Geraghty | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-28 ~ 2024-06-27 |
| Georgios Mihalopulos | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2018-06-28 ~ 2023-06-27 |
| Andrew Wakeman | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-28 ~ 2022-06-27 |
| Maryam Ahmed | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Sana Fatima | 64 Robbins St, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Fahmida Mcgann | 64 Robbins St, Waterbury, CT 06708-2613 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| Jennifer Lee | 64 Robbins St, Waterbury, CT 06708-2600 | Resident Physician | 2020-12-01 ~ 2021-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marian Saba | 64 Robbins St # 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Rusudan Matcharashvili | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Sandeep Sachidananda | 64 Robbins St Rm 1303, Waterbury, CT 06708-2613 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Katelyn Crowley | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Sidhant Singh | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Camila E Rodriguez Buljubasich | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Sara Soliman | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Mojtaba Mirzaei | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2019-06-10 ~ 2022-06-22 |
| Rohit Singh | 64 Robbins St Rm 3304, Waterbury, CT 06708-2613 | Resident Physician | 2018-06-11 ~ 2021-06-30 |
| Gilana Finogenov | 64 Robbins St # 3304, Waterbury, CT 06708-2613 | Resident Physician | 2018-06-11 ~ 2021-06-30 |
| Find all Licenses in zip 06708-2613 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lee Ann M Soden · Schmacher | 925 Oronoke Rd, Waterbury, CT 06708 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Sega Ready Mix | 310 Chase River Rd, Waterbury, CT 06708 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Mary F Chinn | 24 Taft Pointe Unit 47, Waterbury, CT 06708 | Notary Public Appointment | 2005-09-01 ~ 2010-08-31 |
| Joseph Silva | 65 Dixie Ave., Waterbury, CT 06708 | Medication Administration Certification | 2020-06-03 ~ 2022-06-02 |
| Mandy M Desjarlais | 171 Herschel Ave, Waterbury, CT 06708 | Licensed Practical Nurse | 2020-07-01 ~ 2021-06-30 |
| Francisco J Colon Rodriguez LLC | 55 Eastern Ave Apt42, Waterbury, CT 06708 | Home Improvement Contractor | 2020-06-24 ~ 2020-11-30 |
| Morgan Sunyoung Heo | 1249 West Main Street, Waterbury, CT 06708 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Peter Mmangisa Chonga | 119 Taft Pt, Waterbury, CT 06708 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Xuemei Li | 28 Cronin Dr, Waterbury, CT 06708 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Tasheaka R Jones | 151 Park Terr, Waterbury, CT 06708 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06708 | |||
| City | WATERBURY |
| Zip Code | 06708 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WATERBURY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Leroy A Pesch | Po Box 12, Sun Valley, ID 83353 | Physician/surgeon | 1994-06-06 ~ 1995-06-30 |
| Nickles Bakery | 1950 N Sugar St, Lima, OH 45801-3140 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Michael Wilhelm Md | 27 Leroy Ave, Valhalla, NY 10595 | Physician/surgeon | 2003-10-02 ~ 2004-06-30 |
| Leroy N Testerman | 11 Winthrop Rd, West Hartford, CT 06110-1656 | Physician/surgeon | 1996-06-12 ~ 1997-08-31 |
| Robert F Leroy | 9423 Viewside Dr, Dallas, TX 75231-1503 | Physician/surgeon | ~ 1982-07-31 |
| Eric M Grabstein | 57 Leroy Avenue, Valhalla, NY 10595 | Physician/surgeon | 1994-09-14 ~ 1995-09-30 |
| Leroy W Krumperman Jr | 202 Grindlebrook Road, Glastonbury, CT 06073 | Physician/surgeon | 2019-07-01 ~ 2020-06-30 |
| Nickles Bakery | 26 Main St N, Navarre, OH 44662-1158 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Leroy G Talley · Leroy's Home Improvement | 179 Stevenson Rd, Fairfield, CT 06432 | Lead Abatement Supervisor | 2007-01-18 ~ 2007-12-31 |
| Leroy Moye · Leroy Moye Painting | 298 Wheeler Ave, Bridgeport, CT 06606 | Home Improvement Contractor | 2005-06-13 ~ 2005-11-30 |
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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).