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 |
Please comment or provide details below to improve the information on IRA D MICKENBERG.
| 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).