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  5. MATHEW M. CHACKO, PHYSICIAN, P.C.

MATHEW M. CHACKO, PHYSICIAN, P.C.

Company Details

Name: MATHEW M. CHACKO, PHYSICIAN, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 16 Jan 1997 (28 years ago)
Entity Number: 2103182
ZIP code: 11787
County: Suffolk
Place of Formation: New York
Principal Address: 319 MIDDLE COUNTRY RD, STE 5, SMITHTOWN, NY, United States, 11787
Address: 319 MIDDLE COUNTRY RD, STE 5, SMITTOWN, NY, United States, 11787

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2015 113365517 2016-10-11 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2014 113365517 2015-10-07 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2013 113365517 2014-07-24 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2012 113365517 2013-07-19 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2013-07-19
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2011 113365517 2012-06-14 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Plan administrator’s name and address
Administrator’s EIN 113365517
Plan administrator’s name MATHEW M. CHACKO, PHYSICIAN, P.C.
Plan administrator’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787
Administrator’s telephone number 6313600303

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2010 113365517 2011-05-24 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Plan administrator’s name and address
Administrator’s EIN 113365517
Plan administrator’s name MATHEW M. CHACKO, PHYSICIAN, P.C.
Plan administrator’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787
Administrator’s telephone number 6313600303

Signature of
Role Plan administrator
Date 2011-05-24
Name of individual signing MATHEW CHACKO
MATHEW M. CHACKO, M.D., D.P.N. PROFIT SHARING PLAN 2009 113365517 2010-09-29 MATHEW M. CHACKO, PHYSICIAN, P.C. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2001-01-01
Business code 621112
Sponsor’s telephone number 6313600303
Plan sponsor’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787

Plan administrator’s name and address
Administrator’s EIN 113365517
Plan administrator’s name MATHEW M. CHACKO, PHYSICIAN, P.C.
Plan administrator’s address 317 E. MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787
Administrator’s telephone number 6313600303

Signature of
Role Plan administrator
Date 2010-09-29
Name of individual signing MATHEW CHACKO

DOS Process Agent

Name Role Address
MATHEW M. CHACKO, PHYSICIAN, P.C. DOS Process Agent 319 MIDDLE COUNTRY RD, STE 5, SMITTOWN, NY, United States, 11787

Chief Executive Officer

Name Role Address
MATHEW M CHACKO MD Chief Executive Officer 319 MIDDLE COUNTRY RD, STE 5, SMITHTOWN, NY, United States, 11787

History

Start date End date Type Value
2011-01-28 2017-01-03 Address 317 MIDDLE COUNTRY RD, STE 1, SMITHTOWN, NY, 11787, USA (Type of address: Chief Executive Officer)
2011-01-28 2017-01-03 Address 317 MIDDLE COUNTRY RD, STE 1, SMITHTOWN, NY, 11787, USA (Type of address: Principal Executive Office)
2011-01-28 2017-01-03 Address 317 MIDDLE COUNTRY RD, STE 1, SMITTOWN, NY, 11787, USA (Type of address: Service of Process)
1999-02-04 2011-01-28 Address 222 EAST MAIN STREET, NEW YORK, NY, 11787, USA (Type of address: Chief Executive Officer)
1999-02-04 2011-01-28 Address 222 EAST MAIN STREET, NEW YORK, NY, 11787, USA (Type of address: Principal Executive Office)
1997-01-16 2011-01-28 Address 222 EAST MAIN STREET, SMITHTOWN, NY, 11787, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
190109060405 2019-01-09 BIENNIAL STATEMENT 2019-01-01
170103006780 2017-01-03 BIENNIAL STATEMENT 2017-01-01
150113006365 2015-01-13 BIENNIAL STATEMENT 2015-01-01
130122006214 2013-01-22 BIENNIAL STATEMENT 2013-01-01
110128002155 2011-01-28 BIENNIAL STATEMENT 2011-01-01
090113002808 2009-01-13 BIENNIAL STATEMENT 2009-01-01
070222002762 2007-02-22 BIENNIAL STATEMENT 2007-01-01
050209002703 2005-02-09 BIENNIAL STATEMENT 2005-01-01
030211002586 2003-02-11 BIENNIAL STATEMENT 2003-01-01
010213002496 2001-02-13 BIENNIAL STATEMENT 2001-01-01

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 21 Jan 2025

Sources: New York Secretary of State

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