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BROADWAY INTERNAL MEDICINE ASSOCIATES, P.C.

Company Details

Name: BROADWAY INTERNAL MEDICINE ASSOCIATES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 02 Nov 1992 (33 years ago)
Entity Number: 1677261
ZIP code: 11758
County: Nassau
Place of Formation: New York
Address: 585 BROADWAY, MASSAPEQUA, NY, United States, 11758

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
STANLEY FOX Chief Executive Officer 585 BROADWAY, MASSAPEQUA, NY, United States, 11758

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 585 BROADWAY, MASSAPEQUA, NY, United States, 11758

National Provider Identifier

NPI Number:
1952446189

Authorized Person:

Name:
DR. CHARLES K MICELI
Role:
PRES
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5167970190

Form 5500 Series

Employer Identification Number (EIN):
113124087
Plan Year:
2020
Number Of Participants:
6
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
16
Sponsors Telephone Number:

History

Start date End date Type Value
2004-12-20 2017-09-05 Address 585 BROADWAY, MASSAPEQUA, NY, 11758, USA (Type of address: Chief Executive Officer)
1993-11-08 2004-12-20 Address 585 BROADWAY, MASSAPEQUA, NY, 11758, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
170905006523 2017-09-05 BIENNIAL STATEMENT 2016-11-01
130201006256 2013-02-01 BIENNIAL STATEMENT 2012-11-01
101117002962 2010-11-17 BIENNIAL STATEMENT 2010-11-01
081027002849 2008-10-27 BIENNIAL STATEMENT 2008-11-01
061025002804 2006-10-25 BIENNIAL STATEMENT 2006-11-01

Date of last update: 15 Mar 2025

Sources: New York Secretary of State