STEPHEN M WITTENBERG
Physician/surgeon


Address: 256 Overbrook Rd, Long Meadow, MA 01106

STEPHEN M WITTENBERG (Credential# 539884) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 25, 1996. The license expiration date date is October 31, 1997. The license status is INACTIVE.

Business Overview

STEPHEN M WITTENBERG is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.011081. The credential type is physician/surgeon. The effective date is September 25, 1996. The expiration date is October 31, 1997. The business address is 256 Overbrook Rd, Long Meadow, MA 01106. The current status is inactive.

Basic Information

Licensee Name STEPHEN M WITTENBERG
Credential ID 539884
Credential Number 1.011081
Credential Type Physician/Surgeon
Business Address 256 Overbrook Rd
Long Meadow
MA 01106
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1962-08-24
Effective Date 1996-09-25
Expiration Date 1997-10-31
Refresh Date 2009-07-08

Office Location

Street Address 256 OVERBROOK RD
City LONG MEADOW
State MA
Zip Code 01106

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Susan M Neville 43 Lincoln Road, Longmeadow, MA 01106 Registered Nurse 2020-07-01 ~ 2021-06-30
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City LONG MEADOW
Zip Code 01106
License Type Physician/Surgeon
License Type + County Physician/Surgeon + LONG MEADOW

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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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