JESSICA P JACOBS MD (Credential# 921631) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 15, 2010. The license expiration date date is March 31, 2011. The license status is INACTIVE.
JESSICA P JACOBS MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.048885. The credential type is physician/surgeon. The effective date is June 15, 2010. The expiration date is March 31, 2011. The business address is 83 Clinton St, Gouverneur, NY 13642-1039. The current status is inactive.
| Licensee Name | JESSICA P JACOBS MD |
| Credential ID | 921631 |
| Credential Number | 1.048885 |
| Credential Type | Physician/Surgeon |
| Business Address |
83 Clinton St Gouverneur NY 13642-1039 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2010-06-15 |
| Effective Date | 2010-06-15 |
| Expiration Date | 2011-03-31 |
| Refresh Date | 2011-07-01 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 942550 | CSP.0047900 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2010-07-15 | 2010-07-15 - 2011-02-28 | INACTIVE |
| Street Address | 83 CLINTON ST |
| City | GOUVERNEUR |
| State | NY |
| Zip Code | 13642-1039 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kph Healthcare Services · Kinney Drugs Cf | 471 E Main St Unit #5, Gouverneur, NY 13642 | Nonresident Pharmacy | 2019-09-01 ~ 2020-08-31 |
| Bruce B Clark | 151 Clinton Street, Gouverneur, NY 13642 | Professional Engineer | 2004-02-01 ~ 2005-01-31 |
| Donna Thorpe · Todriff | 11 Office Rd, Gouverneur, NY 13642 | Licensed Practical Nurse | 2009-01-20 ~ 2010-03-31 |
| William C Baerthlein | 150 Rock Island Street, Gouverneur, NY 13642 | Physician/surgeon | 2008-07-31 ~ 2009-07-31 |
| Riverside Iron Works Inc · Msc.00154 | 21 Water St, Gouverneur, NY 13642 | Major Contractor | 2001-07-01 ~ 2002-06-30 |
| William D Turner | 2408 California Rd, Gouverneur, NY 13642-3239 | Paramedic | 2019-12-01 ~ 2020-11-30 |
| Proact Pharmacy Services Inc | 1226 Us Highway 11, Gouverneur, NY 13642-3502 | Nonresident Pharmacy | 2019-09-01 ~ 2020-08-31 |
| City | GOUVERNEUR |
| Zip Code | 13642 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + GOUVERNEUR |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Benjamin Richard Jacobs | CT | Physician/surgeon | ~ 1992-03-31 |
| Larry E. Jacobs | 234 Fountain St, New Haven, CT 06515-1915 | Physician/surgeon | 1985-07-29 ~ 1987-12-31 |
| Lloydine J Jacobs | 110 E. Ridgewood Ave, Paramus, NJ 07652 | Physician/surgeon | 2019-08-01 ~ 2020-07-31 |
| Samuel Jacobs | 21 E Lake Cir, Medford, NJ 08055-3440 | Physician/surgeon | 1988-05-13 ~ 1990-12-31 |
| Michael I Jacobs | 407 E 70th St, New York, NY 10021 | Physician/surgeon | 2016-01-01 ~ 2016-12-31 |
| Helene R Jacobs | 706 Eleventh Ave, Huntington, WV 25701 | Physician/surgeon | 1996-11-18 ~ 1997-10-31 |
| Scott R Berger | 62 Jacobs Hill Rd, Mansfield, CT 06250 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Angelina L Jacobs | 15 Two Buck Ring, Burlington, CT 06013 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Janis D Cooley-jacobs Md | 299 Washington Ave, Hamden, CT 06525 | Physician/surgeon | 1999-05-26 ~ 2000-05-31 |
| David S Jacobs | 300 Westage Business Ctr Dr Ste 280, Fishkill, NY 12524-2236 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
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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).