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INGEBORG DZIEDZIC, M.D., P.C.

Company Details

Name: INGEBORG DZIEDZIC, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 17 Jul 1992 (33 years ago)
Entity Number: 1652468
ZIP code: 10570
County: Westchester
Place of Formation: New York
Address: 320 MANVILLE ROAD, PLEASANTVILLE, NY, United States, 10570
Principal Address: 24 SUNSET DRIVE, OSSINING, NY, United States, 10570

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
INGEBORG DZIEDZIC, M.D. Chief Executive Officer 320 MANVILLE ROAD, PLEASANTVILLE, NY, United States, 10570

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 320 MANVILLE ROAD, PLEASANTVILLE, NY, United States, 10570

National Provider Identifier

NPI Number:
1356618193

Authorized Person:

Name:
MRS. NORA DEMPSEY
Role:
BILLING REPRESENTATIVE
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Fax:
9147691405

History

Start date End date Type Value
1992-07-17 2023-04-19 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
121004002383 2012-10-04 BIENNIAL STATEMENT 2012-07-01
100723002548 2010-07-23 BIENNIAL STATEMENT 2010-07-01
080722003248 2008-07-22 BIENNIAL STATEMENT 2008-07-01
040803002048 2004-08-03 BIENNIAL STATEMENT 2004-07-01
020617002701 2002-06-17 BIENNIAL STATEMENT 2002-07-01

Date of last update: 15 Mar 2025

Sources: New York Secretary of State