IRA D MICKENBERG (Credential# 541158) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2011. The license expiration date date is September 30, 2012. The license status is INACTIVE.
IRA D MICKENBERG is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.014557. The credential type is physician/surgeon. The effective date is October 1, 2011. The expiration date is September 30, 2012. The business address is 312 Three Mile Hill Rd, Middlebury, CT 06762-1711. The current status is inactive.
Licensee Name | IRA D MICKENBERG |
Credential ID | 541158 |
Credential Number | 1.014557 |
Credential Type | Physician/Surgeon |
Business Address |
312 Three Mile Hill Rd Middlebury CT 06762-1711 |
Business Type | INDIVIDUAL |
Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
Issue Date | 1970-08-06 |
Effective Date | 2011-10-01 |
Expiration Date | 2012-09-30 |
Refresh Date | 2013-01-07 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
146884 | CSP.0000424 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-03-01 - 2009-02-28 | INACTIVE |
Street Address | 312 Three Mile Hill Rd |
City | MIDDLEBURY |
State | CT |
Zip Code | 06762-1711 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Patricia C Fahey Ms | 312 Three Mile Hill Rd, Middlebury, CT 06762-1711 | Registered Nurse | 2019-01-01 ~ 2019-12-31 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Joanne L Kaday | 364 Three Mile Hill Rd, Middlebury, CT 06762-1711 | Radiographer | 2020-09-01 ~ 2021-08-31 |
Donna M Devino | 330 Three Mile Hill Rd, Middlebury, CT 06762-1711 | Radiographer | 2019-10-01 ~ 2020-09-30 |
Gary J Welton | 286 Three Mile Hill Rd, Middlebury, CT 06762-1711 | Wholesaler Salesman | 2015-02-02 ~ 2017-01-31 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Patricia E Rosa · Lambo | 76 East Farm Rd, Middlebury, CT 06762 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
Kathy Ann Calo · Bellino | 116 Carriage Drive, Middlebury, CT 06762 | Hairdresser/cosmetician | 2020-06-01 ~ 2022-05-31 |
Laurie V Massetti | 60 Yale Avenue, Middlebury, CT 06762 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
Timex Corp | Park Rd Ext, Middlebury, CT 06762 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
Margaret E Mowrey | 57 Marney Drive, Middlebury, CT 06762 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
Giuseppe Tripodi | 687 Straits Tpk, Middlebury, CT 06762 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
Elise L Callahan | 77 Christian Rd, Middlebury, CT 06762 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
Michelle King | 91 Kissewaug Rd, Middlebury, CT 06762 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
Michael F Simms IIi | 80 Burr Hall Road, Middlebury, CT 06762 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Kelly M Barbaris | 62 Yale Avenue, Middlebury, CT 06762 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
Find all Licenses in zip 06762 |
City | MIDDLEBURY |
Zip Code | 06762 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + MIDDLEBURY |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
Barbara M Galko Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2010-06-01 ~ 2011-05-31 |
Sajot S Grewal Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2004-01-30 ~ 2005-03-31 |
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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).