WALEED NE IBRAHIM (Credential# 1653183) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is June 28, 2019. The license expiration date date is June 30, 2022. The license status is ACTIVE.
WALEED NE IBRAHIM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.062826-RES. The credential type is resident physician. The effective date is June 28, 2019. The expiration date is June 30, 2022. The business address is 263 Farmington Ave, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | WALEED NE IBRAHIM |
| Credential ID | 1653183 |
| Credential Number | 1.062826-RES |
| Credential Type | Resident Physician |
| Credential SubCategory | RES |
| Business Address |
263 Farmington Ave Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-06-28 |
| Effective Date | 2019-06-28 |
| Expiration Date | 2022-06-30 |
| Refresh Date | 2019-05-01 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1654116 | CSP.0070758 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-05-06 | 2019-05-06 - 2021-02-28 | ACTIVE |
| Street Address | 263 FARMINGTON AVE |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Matthew D Goranson | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2026-06-30 |
| Jacob Silver | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Nicholas Bellas | 263 Farmington Ave, Farmington, CT 06032-1956 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Jennifer Hale | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Cory R Hewitt | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Sango Huwaa Mosia Asante | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Ryan Desrochers | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2025-06-30 |
| Kelsey D Greenhalgh | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Derek J Tow | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Dentist | 2019-07-01 ~ 2025-06-30 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Omar Ibrahim | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Rawan J.j. Sarsour | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Provisional Faculty Dentist | 2020-04-21 ~ 2021-04-30 |
| Angela Hart | General Medicine- Outpatient Pavilion, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | Resident Physician |
| License Type + County | Resident Physician + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Waleed Siddiqui | 130 Division St, Derby, CT 06418-1326 | Resident Physician | 2017-07-01 ~ 2022-06-30 |
| Waleed Shahzad Malik | 70 Rock Ridge Drive, Rye Brook, NY 10573-1216 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Wael S. Ibrahim | 20 York Street, New Haven, CT 06450 | Resident Physician | 2020-07-01 ~ 2021-06-30 |
| Waleed Naeem Ibrahim | 263 Farmington Ave, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | ~ |
| Ibrahim Sandokji | 1102 Avalon Drive, Shelton, CT 06484 | Resident Physician | 2017-07-01 ~ 2021-06-30 |
| Ibrahim & Ibrahim Engrs | 42 Border St, Deedham, MA 02026 | Professional Engineer | 1988-03-11 ~ 1989-01-31 |
| Giovanni Ibrahim | 175 Mountain Brook Dr, Cheshire, CT 06410-3563 | Resident Dentist | 2020-07-01 ~ 2021-06-30 |
| Waleed Food Mart | 288 Middle Tpke W, Manchester, CT 06040-3842 | Retail Dairy Store | 2018-10-03 ~ 2020-06-30 |
| Waleed Food Mart LLC | 288 Middle Tpke W, Manchester, CT 06040-3842 | Retail Gasoline Dealer | 2018-10-29 ~ 2019-10-31 |
| Waleed Food Mart LLC | 55 Oakland St, Manchester, CT 06042-2363 | Non Legend Drug Permit | 2018-01-01 ~ 2018-12-31 |
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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).