JACK J FOREST MD
Physician/surgeon


Address: 111 Harbor Rd, Westport, CT 06880

JACK J FOREST MD (Credential# 546191) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 23, 2006. The license expiration date date is April 30, 2007. The license status is INACTIVE.

Business Overview

JACK J FOREST MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.026805. The credential type is physician/surgeon. The effective date is May 23, 2006. The expiration date is April 30, 2007. The business address is 111 Harbor Rd, Westport, CT 06880. The current status is inactive.

Basic Information

Licensee Name JACK J FOREST MD
Credential ID 546191
Credential Number 1.026805
Credential Type Physician/Surgeon
Business Address 111 Harbor Rd
Westport
CT 06880
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1985-09-19
Effective Date 2006-05-23
Expiration Date 2007-04-30
Refresh Date 2009-07-11

Other licenses

ID Credential Code Credential Type Issue Term Status
155365 CSP.0013563 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2006-03-01 - 2007-02-28 INACTIVE

Office Location

Street Address 111 HARBOR RD
City WESTPORT
State CT
Zip Code 06880

Licenses in the same location

Licensee Name Office Address Credential Effective / Expiration
Sherl M Forest 111 Harbor Rd, Westport, CT 06880 Marital and Family Therapist 2014-09-01 ~ 2015-08-31

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Toni L Bucker 4 Wild Rose Rd, Westport, CT 06880 Registered Nurse 2020-07-01 ~ 2021-06-30
Jee Hyun Kim 1 Allen Lane, Westport, CT 06880 Combination Nail Technician, Esthetician Or Eyelash Technici 2020-06-26 ~ 2021-07-31
Donna Vaccarella 15 Keyser Rd, Westport, CT 06880 Hairdresser/cosmetician 2020-09-01 ~ 2022-08-31
Sandra Gibson 12 Bayberry Ln, Westport, CT 06880 Registered Nurse 2020-08-01 ~ 2021-07-31
Adil Salam Md 44 Crawford Rd, Westport, CT 06880 Physician/surgeon 2020-07-01 ~ 2021-06-30
Joanne C Sosnoski 24 Hawatha Lane, Westport, CT 06880 Dental Hygienist 2020-08-01 ~ 2021-07-31
Rachel Lynn 495 Post Rd East, Westport, CT 06880 Eyelash Technician ~
Beginnings: An Infant/toddler Program 71 Hillandale Road, Westport, CT 06880 Group Child Care Home 2018-01-01 ~ 2021-12-31
Shelley S Ross 28 Old Hill Farms Rd, Westport, CT 06880 Dietitian/nutritionist 2020-08-01 ~ 2021-07-31
Robert W Van Summern 279 Wilton Rd, Westport, CT 06880 Architect 2020-08-01 ~ 2021-07-31
Find all Licenses in zip 06880

Competitor

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City WESTPORT
Zip Code 06880
License Type Physician/Surgeon
License Type + County Physician/Surgeon + WESTPORT

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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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