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DAVID M. HERZOG M.D., P.C.

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Company Details

Name: DAVID M. HERZOG M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Inactive
Date of registration: 11 Oct 1994 (31 years ago)
Date of dissolution: 25 Oct 2023
Entity Number: 1858351
ZIP code: 10314
County: Richmond
Place of Formation: New York
Address: 1855 RICHMOND AVENUE, STATEN ISLAND, NY, United States, 10314
Principal Address: 4855 HYLAN BLVD, STATEN ISLAND, NY, United States, 10312

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
DAVID M HERZOG Chief Executive Officer 4855 HYLAN BLVD, STATEN ISLAND, NY, United States, 10312

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 1855 RICHMOND AVENUE, STATEN ISLAND, NY, United States, 10314

National Provider Identifier

NPI Number:
1033225370

Authorized Person:

Name:
DAVID M HERZOG
Role:
OWNER PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
207VX0201X - Gynecologic Oncology Physician
Is Primary:
Yes

Contacts:

Fax:
7187617226

History

Start date End date Type Value
2013-05-22 2023-10-25 Address 1855 RICHMOND AVENUE, STATEN ISLAND, NY, 10314, USA (Type of address: Service of Process)
1998-10-20 2013-05-22 Address 4855 HYLAN BLVD, STATEN ISLAND, NY, 10312, USA (Type of address: Service of Process)
1998-10-20 2023-10-25 Address 4855 HYLAN BLVD, STATEN ISLAND, NY, 10312, USA (Type of address: Chief Executive Officer)
1996-11-06 1998-10-20 Address 1501 RICHMOND RD, STATEN ISLAND, NY, 10304, USA (Type of address: Principal Executive Office)
1996-11-06 1998-10-20 Address 1501 RICHMOND RD, STATEN ISLAND, NY, 10304, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
231025002562 2023-05-11 CERTIFICATE OF DISSOLUTION-CANCELLATION 2023-05-11
130522000099 2013-05-22 CERTIFICATE OF CHANGE 2013-05-22
041228002153 2004-12-28 BIENNIAL STATEMENT 2004-10-01
001020002342 2000-10-20 BIENNIAL STATEMENT 2000-10-01
981020002263 1998-10-20 BIENNIAL STATEMENT 1998-10-01

Paycheck Protection Program

Jobs Reported:
18
Initial Approval Amount:
$162,500
Date Approved:
2020-05-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$162,500
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$164,364.24
Servicing Lender:
TD Bank, National Association
Use of Proceeds:
Payroll: $162,500

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Date of last update: 15 Mar 2025

Sources: New York Secretary of State