MEL A FORMAN (Credential# 540624) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
MEL A FORMAN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.013175. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 46 White Fall Ln, New Canaan, CT 06840-2039. The current status is active.
| Licensee Name | MEL A FORMAN |
| Credential ID | 540624 |
| Credential Number | 1.013175 |
| Credential Type | Physician/Surgeon |
| Business Address |
46 White Fall Ln New Canaan CT 06840-2039 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1967-10-27 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-06-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 158199 | CSP.0016929 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 | 2017-08-07 - 2019-02-28 | LAPSED |
| Street Address | 46 WHITE FALL LN |
| City | NEW CANAAN |
| State | CT |
| Zip Code | 06840-2039 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| 49 Midwood LLC | 97 Dans Hwy, New Canaan, CT 06840 | New Home Construction Contractor | 2020-06-26 ~ 2021-09-30 |
| Hyun Park | 15 Locust Ave, New Canaan, CT 06840 | Esthetician | 2020-06-26 ~ 2022-04-30 |
| Guy R Mazzola | 1484 Oenoke Ridge, New Canaan, CT 06840 | Public Weigher | 2020-07-01 ~ 2021-06-30 |
| Mairin E Mara | 184 Lukes Wood Rd, New Canaan, CT 06840 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Hannah Simpson | 33 Sleepy Hollow Road, New Canaan, CT 06840 | Esthetician | ~ |
| Susan Mcclellan Valk | 301 Oenoke Ridge Road, New Canaan, CT 06840 | Real Estate Salesperson | 2020-06-23 ~ 2021-05-31 |
| New Canaan Gulf · Haviland Ent Ltd Dba | 36 South Ave, New Canaan, CT 06840 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Claire Cheng | 226 Buttery Road, New Canaan, CT 06840 | Marital and Family Therapist Associate | 2020-06-24 ~ 2022-06-24 |
| Joes Pizza | 23 Locust Avenue, New Canaan, CT 06840 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Kathleen Mary Berchelmann | 711 Silvermine Rd, New Canaan, Ct, CT 06840 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06840 | |||
| City | NEW CANAAN |
| Zip Code | 06840 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + NEW CANAAN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Howard P Forman | 100 Temple St, New Haven, CT 06510 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Peter H Forman Jr | 29 Ten Eyck Avenue, Albany, NY 12209 | Physician/surgeon | 2003-02-13 ~ 2003-12-31 |
| Barr H Forman | 200 Orchard Street, New Haven, CT 06511 | Physician/surgeon | 2006-02-17 ~ 2007-04-30 |
| Robin Forman Rose | 195 Danbury Rd, Wilton, CT 06897-4075 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Richard Forman · Forman Vineyard | 1501 Big Rock Rd, Saint Helena, CA 94574-9613 | Out of State Winery | 2015-04-01 ~ 2016-03-31 |
| Ce Forman T V & Applian · Forman T V & Appliance | E Liberty St, Chester, CT 06412 | Tv & Radio Service Dealer | ~ |
| The Forman School Inc · Peirce Dining Hall | 12 Norfolk Rd, Litchfield, CT 06759-2537 | Frozen Dessert Retailer | 2020-01-01 ~ 2020-12-31 |
| Forman Industries Inc · F I Companies | 3150 Bordentown Ave, Old Bridge, NJ 08857-9703 | Major Contractor | 2017-05-09 ~ 2017-06-30 |
| Sandi Richards Forman | 31 Milwaukee Avenue, Bethel, CT 06801 | Certified Public Accountant Firm Permit | 1990-02-22 ~ 1990-12-31 |
| Forman School | Norfolk Road, Litchfield, CT 06759 | Public Charity-exempt From Financial Requirements | ~ |
Please comment or provide details below to improve the information on MEL A FORMAN.
| 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).