PARK AVENUE MEDICAL CENTER (Credential# 552817) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
PARK AVENUE MEDICAL CENTER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.035224. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is Bridgeport Hospital, Bridgeport, CT 06610. The current status is active.
| Licensee Name | PARK AVENUE MEDICAL CENTER |
| Business Name | PARK AVENUE MEDICAL CENTER |
| Credential ID | 552817 |
| Credential Number | 1.035224 |
| Credential Type | Physician/Surgeon |
| Business Address |
Bridgeport Hospital Bridgeport CT 06610 |
| Business Type | BUSINESS |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1996-05-03 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1332261 | CSP.0062069 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2016-02-05 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 400109 | CSP.0037232 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2005-04-11 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 174830 | CSP.0024324 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-02-29 - 2005-02-28 | INACTIVE |
| Street Address | BRIDGEPORT HOSPITAL |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06610 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Bozena K. Malyszko | Bridgeport Hospital, Bridgeport, CT 06610 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Ashwin Deshmukh | Bridgeport Hospital, Bridgeport, CT 06610-0120 | Controlled Substance Registration for Practitioner | 2019-06-28 ~ 2021-02-28 |
| Steven L. Belmont | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Bernard B Jordan | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Vinson T Varughese | Bridgeport Hospital, Bridgeport, CT 06610 | Physician Assistant | 2019-04-01 ~ 2020-03-31 |
| Maximilian Klein | Bridgeport Hospital, Bridgeport, CT 06610-2805 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Shawn Nguyen | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Tess T Jacob | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2015-04-13 ~ 2017-02-28 |
| Benjamin E Bailey | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Arti Singh | Bridgeport Hospital, Bridgeport, CT 06610 | Controlled Substance Registration for Practitioner | 2012-10-03 ~ 2013-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nilca Janice Cardenales | 66 Rose St, Bridgeport, CT 06610 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Kiara Lizbeth Corporan | 10 Sturtevant Pl, Bridgeport, CT 06610 | Eyelash Technician | ~ |
| Alisha Garcia | 65 Berkeley Place, Bridgeport, CT 06610 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Pauline Parkes | 96 Virginia Avenue, Bridgeport, CT 06610 | Licensed Clinical Social Worker | ~ |
| Denise Reyes | 1125 Huntington Turnpike, Bridgeport, CT 06610 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Avery M Rilley | 80 Granfield Avenue, Bridgeport, CT 06610 | Pharmacy Technician | 2020-06-25 ~ 2021-03-31 |
| Amy Espinosa | 146 Court D, Bridgeport, CT 06610 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Wilhelmina Jackson · Thomas | 172 Court D, Bridgeport, CT 06610 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Emma Agyeiwaa Vaczek | P.o Box 5223, Bridgeport, CT 06610 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Belma Dedovic | 68 Barclay St, Bridgeport, CT 06610 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06610 | |||
| City | BRIDGEPORT |
| Zip Code | 06610 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + BRIDGEPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Park Avenue Early Childhood Center | 29 Park Ave, Danbury, CT 06810-6413 | Child Care Center | 2019-12-16 ~ 2023-12-31 |
| 3030 Park Health Center Inc. · 3030 Park Health Center, Inc. | 3030 Park Avenue, Bridgeport, CT 06604 | Chronic & Convalescent Nursing Home | 2001-10-01 ~ 2003-09-30 |
| Park City Primary Care Center Inc. · Park City Primary Care Center, Inc. | 695 Park Avenue, Bridgeport, CT 06604 | Outpatient Clinic | ~ 2001-12-31 |
| Park City Primary Care Center Inc. | 695 Park Avenue, Bridgeport, CT 06604 | Public Charity | ~ |
| Southend Community Childcare Center @ Hyland Park | 355 New Britain Avenue, Hartford, CT 06108 | Child Care Center | 2006-09-06 ~ |
| 3030 Park Fairfield Health Center Inc. | 3030 Park Avenue, Bridgeport, CT 06604 | Public Charity-exempt From Financial Requirements | ~ |
| 3030 Park Health Center Inc. (fka Interchurch Residences) | 3030 Park Avenue, Bridgeport, CT 06604 | Public Charity-exempt From Financial Requirements | ~ |
| Park Place Health Center | 5 Greenwood St, Hartford, CT 06106-2110 | Chronic & Convalescent Nursing Home | 2017-10-01 ~ 2019-09-30 |
| Apple Orchard Learning Center | 3160 Park Avenue, Bridgeport, CT 06604 | Child Care Center | ~ 1997-11-30 |
| Parkville Early Learning Center | 19 New Park Avenue, Hartford, CT 06106 | Child Care Center | 2009-03-05 ~ |
Please comment or provide details below to improve the information on PARK AVENUE MEDICAL CENTER.
| 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).