WIBOWO S SUSENO MD (Credential# 553944) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is March 23, 1999. The license expiration date date is May 31, 2000. The license status is INACTIVE.
WIBOWO S SUSENO MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.036352. The credential type is physician/surgeon. The effective date is March 23, 1999. The expiration date is May 31, 2000. The business address is 18 Thames View Pentway, Gales Ferry, CT 06335. The current status is inactive.
| Licensee Name | WIBOWO S SUSENO MD |
| Credential ID | 553944 |
| Credential Number | 1.036352 |
| Credential Type | Physician/Surgeon |
| Business Address |
18 Thames View Pentway Gales Ferry CT 06335 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1997-08-29 |
| Effective Date | 1999-03-23 |
| Expiration Date | 2000-05-31 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 187467 | CSP.0026090 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 - 2000-02-28 | INACTIVE |
| Street Address | 18 THAMES VIEW PENTWAY |
| City | GALES FERRY |
| State | CT |
| Zip Code | 06335 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sally M Derusha · Mccrea | 8 Brewster Drive, Gales Ferry, CT 06335 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Melissa A Kearney · Seidel | 853 Long Cove Rd, Gales Ferry, CT 06335 | Radiographer | 2020-07-01 ~ 2021-06-30 |
| Thomas Mcgarry | 1649 Ct-12, Gales Ferry, CT 06335 | Cross Connection Survey Inspector | 2020-03-05 ~ 2022-12-31 |
| Barbara J Smith | 5 Woodridge Circle, Gales Ferry, CT 06335 | Notary Public Appointment | 2020-09-01 ~ 2025-08-31 |
| Mary E Hurley | 8 Cornell Court, Gales Ferry, CT 06335 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Ann Marie Hanson Aprn | 31 Washington Drive, Gales Ferry, CT 06335 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Dunkin Donuts #331844 · J J M A Donuts LLC | 1662 Route 12, Gales Ferry, CT 06335 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Mcdonalds | 1678 Rte 12, Gales Ferry, CT 06335 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Carol A Collette | 2 Stonybrook Rd, Gales Ferry, CT 06335 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Reginald L Weed · R L Weed Company | 52a Vinegar Hill Rd, Gales Ferry, CT 06335 | Sub-surface Sewage Installer | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06335 | |||
| City | GALES FERRY |
| Zip Code | 06335 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + GALES FERRY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| 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 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| 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 |
| Susan J Batlan Md | Eye Physician Associates of Hartford, West Hartford, CT 06107 | Physician/surgeon | 2000-07-27 ~ 2001-07-31 |
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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).