IMTIAZ A MALLICK (Credential# 551093) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is September 15, 1998. The license expiration date date is November 30, 1999. The license status is INACTIVE.
IMTIAZ A MALLICK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.033494. The credential type is physician/surgeon. The effective date is September 15, 1998. The expiration date is November 30, 1999. The business address is 152 Freedom Road, Pleasant Valley, NY 12569. The current status is inactive.
| Licensee Name | IMTIAZ A MALLICK |
| Credential ID | 551093 |
| Credential Number | 1.033494 |
| Credential Type | Physician/Surgeon |
| Business Address |
152 Freedom Road Pleasant Valley NY 12569 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1994-01-28 |
| Effective Date | 1998-09-15 |
| Expiration Date | 1999-11-30 |
| Refresh Date | 2009-07-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 162917 | CSP.0021938 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1994-03-16 - 1996-01-01 | INACTIVE |
| Street Address | 152 Freedom Road |
| City | PLEASANT VALLEY |
| State | NY |
| Zip Code | 12569 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Drew W Matsen | 11 Creekside Lane, Pleasant Valley, NY 12569 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
| Ruth R Piehler | 814 Freedom Road, Pleasant Valley, NY 12569 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Roger Allan Bastian | Po Box 680, Pleasant Valley, NY 12569 | Tax Preparer/facilitator Permit | 2020-02-11 ~ 2022-02-28 |
| Heather L Kunkel | 28 West Gretna Rd, Pleasant Valley, NY 12569 | Licensed Clinical Social Worker | 2020-03-01 ~ 2021-02-28 |
| Daniel T Connolly | 36 Grist Mill Lane, Pleasant Valley, NY 12569 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Amanda-rose I Sozzo | 59 Traver Road, Pleasant Valley, NY 12569 | Registered Nurse | 2020-01-01 ~ 2020-12-31 |
| Lori C Nunez | 51 Sunset Hill Road, Pleasant Valley, NY 12569 | Licensed Practical Nurse | 2020-01-01 ~ 2020-12-31 |
| Melanie Lynn Battistoni | 177 Forest Valley Road, Pleasant Valley, NY 12569 | Physical Therapist Assistant | 2019-12-12 ~ 2020-12-31 |
| Robert Stolarski | 120 Barkit Kennell Rd, Pleasant Valley, NY 12569 | Repairer of Weighing & Measuring Devices | 2020-01-01 ~ 2020-12-31 |
| Clark W Angevine | 310 Freedom Road, Pleasant Valley, NY 12569 | Locksmith | 2017-01-01 ~ 2018-12-31 |
| Find all Licenses in zip 12569 | |||
| City | PLEASANT VALLEY |
| Zip Code | 12569 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + PLEASANT VALLEY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Imtiaz Mohamed | 715 Duncan Avenue, Pittsburgh, PA 15237 | Physician/surgeon | ~ 1999-09-30 |
| Abida K Mallick | 267 Mile Square Rd, Yonkers, NY 10701 | Physician/surgeon | 1992-01-23 ~ 1992-12-31 |
| Imtiaz A Khokhar | 42-06 195th Street, Flushing, NY 11358 | Physician/surgeon | 1996-08-02 ~ 1997-09-30 |
| Mubdiul Imtiaz Ali | 300 Cedar St, Tac S425, New Haven, CT 06520 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Imtiaz Ahmad | 52 Main St, Bedford Hills, NY 10507-1814 | Physician/surgeon | 2019-03-01 ~ 2020-02-29 |
| Husein Imtiaz Poonawala | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | Physician/surgeon | 2019-10-01 ~ 2020-10-31 |
| Sumara Imtiaz Choudhry | 2800 Main Street, Bridgeport, CT 06610-1662 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Arthur C Mallick | 5489 Main St, Trumbull, CT 06611 | Dentist | 2019-08-01 ~ 2020-07-31 |
| Edith H Mallick | 135 Sharon Ave, Torrington, CT 06790 | Hairdresser/cosmetician | 2019-02-01 ~ 2021-01-31 |
| Chelsea Mallick | 111 Towne St, Stamford, CT 06902 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
Please comment or provide details below to improve the information on IMTIAZ A MALLICK.
| 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).