OLENA KSOVRELI MD
Controlled Substance Registration for Practitioner


Address: 145 95th St Apt B2, Brooklyn, NY 11209-7236

OLENA KSOVRELI MD (Credential# 516863) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2011. The license expiration date date is February 28, 2013. The license status is INACTIVE.

Business Overview

OLENA KSOVRELI MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0044740. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2011. The expiration date is February 28, 2013. The business address is 145 95th St Apt B2, Brooklyn, NY 11209-7236. The current status is inactive.

Basic Information

Licensee Name OLENA KSOVRELI MD
Credential ID 516863
Credential Number CSP.0044740
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 145 95th St Apt B2
Brooklyn
NY 11209-7236
Business Type INDIVIDUAL
Status INACTIVE
Issue Date 2008-10-21
Effective Date 2011-03-01
Expiration Date 2013-02-28
Refresh Date 2014-01-29

Other licenses

ID Credential Code Credential Type Issue Term Status
564623 1.047041 Physician/Surgeon 2008-09-30 2011-12-01 - 2012-11-30 INACTIVE

Office Location

Street Address 145 95TH ST APT B2
City BROOKLYN
State NY
Zip Code 11209-7236

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City BROOKLYN
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Dataset Information

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).

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