LUBUNMI IFABIYI
Physician/surgeon


Address: 344 Britton Ave, Staten Island, NY 10304-3428

LUBUNMI IFABIYI (Credential# 561177) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2005. The license expiration date date is April 30, 2006. The license status is INACTIVE.

Business Overview

LUBUNMI IFABIYI is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.043595. The credential type is physician/surgeon. The effective date is July 1, 2005. The expiration date is April 30, 2006. The business address is 344 Britton Ave, Staten Island, NY 10304-3428. The current status is inactive.

Basic Information

Licensee Name LUBUNMI IFABIYI
Credential ID 561177
Credential Number 1.043595
Credential Type Physician/Surgeon
Business Address 344 Britton Ave
Staten Island
NY 10304-3428
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2005-07-01
Effective Date 2005-07-01
Expiration Date 2006-04-30
Refresh Date 2009-07-08

Office Location

Street Address 344 BRITTON AVE
City STATEN ISLAND
State NY
Zip Code 10304-3428

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John B Dimaano 800 Elbe Ave, Staten Island, NY 10304 Registered Nurse 2019-04-01 ~ 2020-03-31
Nadezda A Tretyakova 54 Sunrise Terrace, Staten Island, NY 10304 Physician/surgeon 2017-11-01 ~ 2018-10-31
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City STATEN ISLAND
Zip Code 10304
License Type Physician/Surgeon
License Type + County Physician/Surgeon + STATEN ISLAND

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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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