GUNAWAN KARTIKA
Physician/surgeon


Address: 466 Mason Ave, Staten Island, NY 10305-2222

GUNAWAN KARTIKA (Credential# 950415) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2011. The license expiration date date is July 31, 2012. The license status is INACTIVE.

Business Overview

GUNAWAN KARTIKA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.049241. The credential type is physician/surgeon. The effective date is August 1, 2011. The expiration date is July 31, 2012. The business address is 466 Mason Ave, Staten Island, NY 10305-2222. The current status is inactive.

Basic Information

Licensee Name GUNAWAN KARTIKA
Credential ID 950415
Credential Number 1.049241
Credential Type Physician/Surgeon
Business Address 466 Mason Ave
Staten Island
NY 10305-2222
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 2010-09-27
Effective Date 2011-08-01
Expiration Date 2012-07-31
Refresh Date 2012-11-02

Office Location

Street Address 466 MASON AVE
City STATEN ISLAND
State NY
Zip Code 10305-2222

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City STATEN ISLAND
Zip Code 10305
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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