DAVID EZRA MANDELBAUM (Credential# 1659279) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2019. The license expiration date date is October 31, 2020. The license status is ACTIVE.
DAVID EZRA MANDELBAUM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.064335. The credential type is physician/surgeon. The effective date is October 1, 2019. The expiration date is October 31, 2020. The business address is 237 Irving Ave, Providence, RI 02906-5518. The current status is active.
Licensee Name | DAVID EZRA MANDELBAUM |
Credential ID | 1659279 |
Credential Number | 1.064335 |
Credential Type | Physician/Surgeon |
Business Address |
237 Irving Ave Providence RI 02906-5518 |
Business Type | INDIVIDUAL |
Status | ACTIVE - CURRENT |
Active | 1 |
Issue Date | 2019-10-01 |
Effective Date | 2019-10-01 |
Expiration Date | 2020-10-31 |
Refresh Date | 2019-10-03 |
Street Address | 237 IRVING AVE |
City | PROVIDENCE |
State | RI |
Zip Code | 02906-5518 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
The Stephen C. Rose Legacy Foundation · The Steve Fund | 138 Governor Street, Providence, RI 02906 | Public Charity | 2020-06-12 ~ 2021-11-30 |
Moriah Connor | 211 Waterman Street, Unit 20, Providence, RI 02906 | Behavior Analyst | ~ |
Elizabeth Burns | 198 Camp Street, Providence, RI 02906 | Licensed Clinical Social Worker | ~ |
Christine Montross | 345 Blackstone Blvd, Providence, RI 02906 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
Susan Dickstein | 196 Freeman Parkway, Providence, RI 02906 | Psychologist | 2020-07-01 ~ 2021-06-30 |
Victoria S Karlsen | 415 Angell St, Providence, RI 02906 | Behavior Analyst | ~ |
John W O'bell Md | 14 Rose Ct., Providence, RI 02906 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Alexandria Hanul Simon | 323 Angell Street, Providence, RI 02906 | Emergency Medical Technician | ~ |
Molly A Moran | 202 Sixth Street, Providence, RI 02906 | Advanced Practice Registered Nurse | 2020-06-01 ~ 2021-05-31 |
Simon M Cornelissen | 45 Balton Rd, Providence, RI 02906 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
Find all Licenses in zip 02906 |
City | PROVIDENCE |
Zip Code | 02906 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + PROVIDENCE |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
E Ezra Sofair | 14 Keri Lane, New Hempstead, NY 10977 | Physician/surgeon | 1997-05-14 ~ 1998-05-31 |
Ezra Academy | 75 Rimmon Rd, Woodbridge, CT 06525-2003 | Bazaar Permit Class 3 | 2017-01-28 ~ 2017-01-28 |
Christopher David Moran | 78 Ezra Street, North Haven, CT 06473 | Emergency Medical Technician | ~ |
Ezra International | 1615 Sweetwood Dr, Melbourne, FL 32935-4589 | Public Charity | 2019-12-01 ~ 2020-11-30 |
Old Ezra Ksbw 7yr | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2016-07-06 ~ 2019-07-05 |
David L Maxham | Box 517, Woodstock, VT 05091 | Physician/surgeon | 1994-03-07 ~ 1995-02-28 |
David S Wilcox | P.o. Box 384, Osterville, MA 02655 | Physician/surgeon | 1996-03-14 ~ 1997-05-31 |
David G. Srour Md | Rockville, MD 20850 | Physician/surgeon | 2012-07-01 ~ 2013-06-30 |
David A Crowe | Po Box 677, Millwood, NY 10546-0677 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
David M Renison | Po Box 75, Middletown, CT 06457-0075 | Physician/surgeon | 2013-07-01 ~ 2014-06-30 |
Please comment or provide details below to improve the information on DAVID EZRA MANDELBAUM.
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).