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EDISON R. BLANCO, PHYSICIAN, P.C.

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Company Details

Name: EDISON R. BLANCO, PHYSICIAN, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 14 Apr 1998 (27 years ago)
Entity Number: 2249328
ZIP code: 11706
County: Suffolk
Place of Formation: New York
Address: 16 BRENTWOOD RD, BAY SHORE, NY, United States, 11706

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
EDISON R. BLANCO Chief Executive Officer 16 BRENTWOOD RD, BAY SHORE, NY, United States, 11706

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 16 BRENTWOOD RD, BAY SHORE, NY, United States, 11706

National Provider Identifier

NPI Number:
1669631032

Authorized Person:

Name:
EDISON ROQUE BLANCO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2000-04-18 2006-04-24 Address 1991 UNION BLVD., BAY SHORE, NY, 11706, USA (Type of address: Chief Executive Officer)
2000-04-18 2006-04-24 Address 1991 UNION BLVD., BAY SHORE, NY, 11706, USA (Type of address: Principal Executive Office)
2000-04-18 2006-04-24 Address 1991 UNION BLVD., BAY SHORE, NY, 11706, USA (Type of address: Service of Process)
1998-04-14 2000-04-18 Address 1991 UNION BLVD., BAY SHORE, NY, 11706, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
140715002271 2014-07-15 BIENNIAL STATEMENT 2014-04-01
120709002355 2012-07-09 BIENNIAL STATEMENT 2012-04-01
080425002471 2008-04-25 BIENNIAL STATEMENT 2008-04-01
060424002433 2006-04-24 BIENNIAL STATEMENT 2006-04-01
040408002015 2004-04-08 BIENNIAL STATEMENT 2004-04-01

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Date of last update: 31 Mar 2025

Sources: New York Secretary of State