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BOULEVARD MULTISPECIALTY MEDICAL, P.C.

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Company Details

Name: BOULEVARD MULTISPECIALTY MEDICAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 16 Feb 1990 (35 years ago)
Entity Number: 1423674
ZIP code: 11416
County: Queens
Place of Formation: New York
Address: 10149 WOODHAVEN BLVD, OZONE PARK, NY, United States, 11416

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
GORDON DAVIS, DO Chief Executive Officer 101 49 WOODHAVEN BLVD, OZONE PARK, NY, United States, 11416

DOS Process Agent

Name Role Address
GORDON DAVIS, DO DOS Process Agent 10149 WOODHAVEN BLVD, OZONE PARK, NY, United States, 11416

National Provider Identifier

NPI Number:
1730245366

Authorized Person:

Name:
GORDON C DAVIS
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
7186414905

History

Start date End date Type Value
1997-02-14 2002-06-07 Address 101 49 WOODHAVEN BLVD, OZONE PARK, NY, 11416, USA (Type of address: Service of Process)
1997-02-14 2002-06-07 Address 101 49 WOODHAVEN BLVD, OZONE PARK, NY, 11416, USA (Type of address: Chief Executive Officer)
1997-02-14 2002-06-07 Address 101 49 WOODHAVEN BLVD, OZONE PARK, NY, 11416, USA (Type of address: Principal Executive Office)
1993-03-22 1997-02-14 Address 4120 BROADWAY, NEW YORK, NY, 10033, USA (Type of address: Principal Executive Office)
1993-03-22 1997-02-14 Address 4120 BROADWAY, NEW YORK, NY, 10033, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
140416002505 2014-04-16 BIENNIAL STATEMENT 2014-02-01
120320002712 2012-03-20 BIENNIAL STATEMENT 2012-02-01
100414002485 2010-04-14 BIENNIAL STATEMENT 2010-02-01
080219002636 2008-02-19 BIENNIAL STATEMENT 2008-02-01
060314002184 2006-03-14 BIENNIAL STATEMENT 2006-02-01

Paycheck Protection Program

Jobs Reported:
9
Initial Approval Amount:
$53,755
Date Approved:
2021-02-24
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$53,755
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$54,500.1
Servicing Lender:
Itria Ventures LLC
Use of Proceeds:
Payroll: $53,754
Jobs Reported:
10
Initial Approval Amount:
$53,645
Date Approved:
2020-04-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$53,645
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$54,285.8
Servicing Lender:
Customers Bank
Use of Proceeds:
Payroll: $53,645

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Date of last update: 16 Mar 2025

Sources: New York Secretary of State