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WANTAGH INTERNAL MEDICINE, P.C.

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Company Details

Name: WANTAGH INTERNAL MEDICINE, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 02 Feb 1995 (30 years ago)
Entity Number: 1891251
ZIP code: 11514
County: Nassau
Place of Formation: New York
Principal Address: 2155 WANTAGH AVE., WANTAGH, NY, United States, 11793
Address: 55 CHERRY LANE SUITE 101, CARLE PLACE, NY, United States, 11514

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
MITCHELL MUND, ESQ DOS Process Agent 55 CHERRY LANE SUITE 101, CARLE PLACE, NY, United States, 11514

Chief Executive Officer

Name Role Address
ERIC R BARTH Chief Executive Officer 2155 WANTAGH AVE., WANTAGH, NY, United States, 11793

National Provider Identifier

NPI Number:
1629256342

Authorized Person:

Name:
DR. ERIC R BARTH
Role:
DOCTOR
Phone:

Taxonomy:

Selected Taxonomy:
172V00000X - Community Health Worker
Is Primary:
Yes

Contacts:

Fax:
5167858969

History

Start date End date Type Value
2005-03-11 2021-02-02 Address 100-15 QUEENS BLVD, FOREST HILLS, NY, 11375, 2452, USA (Type of address: Service of Process)
1999-02-22 2005-03-11 Address 567 BROADWAY, MASSAPEQUA, NY, 11758, USA (Type of address: Service of Process)
1995-02-02 1999-02-22 Address 6800 JERICHO TURNPIKE, SYOSSET, NY, 11791, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210202061445 2021-02-02 BIENNIAL STATEMENT 2021-02-01
190213060578 2019-02-13 BIENNIAL STATEMENT 2019-02-01
170215006364 2017-02-15 BIENNIAL STATEMENT 2017-02-01
150211006295 2015-02-11 BIENNIAL STATEMENT 2015-02-01
130306006954 2013-03-06 BIENNIAL STATEMENT 2013-02-01

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Date of last update: 14 Mar 2025

Sources: New York Secretary of State