DAVID WALLACE (Credential# 1671893) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is June 28, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
DAVID WALLACE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0071720. The credential type is controlled substance registration for practitioner. The effective date is June 28, 2019. The expiration date is February 28, 2021. The business address is 39 Allen Pl, Staten Island, NY 10312-5901. The current status is active.
| Licensee Name | DAVID WALLACE |
| Credential ID | 1671893 |
| Credential Number | CSP.0071720 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
39 Allen Pl Staten Island NY 10312-5901 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-06-28 |
| Effective Date | 2019-06-28 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-07-01 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1666335 | 23.004572 | Physician Assistant | 2019-09-03 | 2019-09-03 - 2020-09-30 | ACTIVE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| David Wallace | 89 Valley Forge Rd., Weston, CT 06883 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
| Street Address | 39 ALLEN PL |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10312-5901 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| David S Wallace | 39 Allen Pl, Staten Island, NY 10312-5901 | Emergency Medical Technician | 2016-07-15 ~ 2018-04-01 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Biana Volfinzon | 187 Arbutus Ave., Staten Island, NY 10312 | Physician/surgeon | ~ |
| Laren Encarnacion | 482 Wilson Avenue, Staten Island, NY 10312 | Registered Nurse | ~ |
| Joseph J Aliotta | 74 Robinson Ave, Staten Island, NY 10312 | Architect | 2020-08-01 ~ 2021-07-31 |
| David P Suarez | 3733 Richmond Avenue, Staten Island, NY 10312 | Physician/surgeon | 2018-11-01 ~ 2019-10-31 |
| Raven Devincenzo Md | 59 Van Brunt St, Staten Island, NY 10312 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Yanina Gleyzer | 246 Hillcrest Street, Staten Island, NY 10312 | Master's Level Social Worker | 2019-10-01 ~ 2020-09-30 |
| Richard Louis Sosa | 15 Osage Lane, Staten Island, NY 10312 | Registered Nurse | 2019-09-01 ~ 2020-08-31 |
| Janice Riso | 241 Kinghorn St, Staten Island, NY 10312 | Resident Physician | 2015-07-01 ~ 2019-06-30 |
| Bedzet Vejselovski · E. V. Masonry | 169 Rathbun Ave, Staten Island, NY 10312 | Home Improvement Contractor | 2006-01-25 ~ 2006-11-30 |
| Frederick A Barbieri | 62 Covington Circle, Staten Island, NY 10312 | Professional Engineer | 2012-02-01 ~ 2013-01-31 |
| Find all Licenses in zip 10312 | |||
| City | STATEN ISLAND |
| Zip Code | 10312 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + STATEN ISLAND |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| E F Wallace Dvm | Torrington Rd, Litchfield, CT 06759 | Controlled Substance Registration for Practitioner | 1994-04-15 ~ 1996-05-01 |
| Lee Wallace Md | 40 Hart Street, New Britain, CT 06052 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Lydia Wallace | 289 Green St, Boston, MA 02130-2660 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Suemoy Wallace | 80 Seymour St, Hartford, CT 06102-8000 | Controlled Substance Registration for Practitioner | 2009-09-14 ~ 2011-02-28 |
| Richard B Wallace Md | 7 Devonshire Dr, Waterford, CT 06385-1701 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Ramesh B Bandagorla | 2138 Wallace Ave Apt 268, Bronx, NY 10462-2584 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Leah G Wallace | 10 Pattagansett Court, Niantic, CT 06357 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Wallace B Hirschberg | 27 Bridge Street, Stamford, CT 06905 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Elizabeth C Wallace | 1099 Merritt St, Fairfield, CT 06825-1531 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| James M Crowley Pa | 23 Wallace Road, Sturbridge, MA 01566 | Controlled Substance Registration for Practitioner | 2006-03-01 ~ 2007-02-28 |
Please comment or provide details below to improve the information on DAVID WALLACE.
| 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).