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.
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.
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 |
ID | Credential Code | Credential Type | Issue | Term | Status |
---|---|---|---|---|---|
155365 | CSP.0013563 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-03-01 - 2007-02-28 | INACTIVE |
Street Address | 111 HARBOR RD |
City | WESTPORT |
State | CT |
Zip Code | 06880 |
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 |
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 |
City | WESTPORT |
Zip Code | 06880 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + WESTPORT |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Jack Liu | 1345 Rxr Plz, Uniondale, NY 11556-1301 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Jack H Pincus | Pca Century, Tampa, FL 33607 | Physician/surgeon | 1993-04-23 ~ 1994-04-30 |
Jack M Dodick | 535 Park Ave, New York, NY 10021 | Physician/surgeon | 2018-04-26 ~ 2019-03-31 |
Jack Hajjar Md | 169 South Rd, Farmington, CT 06032 | Physician/surgeon | 2001-05-08 ~ 2002-06-30 |
Jack A Miller | 384 West Rd, Alford, MA 01266 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Jack M Charney | Cblpath, Inc., Rye Brook, NY 10573 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Jack F Wilder | 363 Shore Rd, Greenwich, CT 06830 | Physician/surgeon | 1998-01-30 ~ 1999-01-31 |
Jack L Baldasar | 220 Oxford Dr, Tenafly, NJ 07670-3118 | Physician/surgeon | 2015-09-01 ~ 2016-08-31 |
Jack F Perrone | 586 23rd Ave Sw, Rochester, MN 55902-0965 | Physician/surgeon | 2016-04-01 ~ 2017-03-31 |
Jack W Snyder Md | 104 Hilary Cir, Fairfield, CT 06432 | Physician/surgeon | 2003-08-04 ~ 2004-07-31 |
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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).