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PROSPECT MEDICAL GROUP, P.C.

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Company Details

Name: PROSPECT MEDICAL GROUP, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 10 Mar 1999 (26 years ago)
Entity Number: 2354660
ZIP code: 11791
County: Kings
Place of Formation: New York
Principal Address: 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, United States, 11213
Address: 15 WOODCREST DRIVE, SYOSSET, NY, United States, 11791

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
DEVENDRA SHRIVASTAVA Chief Executive Officer 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, United States, 11213

DOS Process Agent

Name Role Address
DEVENDRA SHRIVASTAVA DOS Process Agent 15 WOODCREST DRIVE, SYOSSET, NY, United States, 11791

National Provider Identifier

NPI Number:
1114198504

Authorized Person:

Name:
MR. DARIN DUNN
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
134049723
Plan Year:
2014
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
4
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
4
Sponsors Telephone Number:

History

Start date End date Type Value
2025-03-08 2025-03-08 Address 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, 11213, USA (Type of address: Chief Executive Officer)
2023-03-03 2023-03-03 Address 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, 11213, USA (Type of address: Chief Executive Officer)
2023-03-03 2025-03-08 Address 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, 11218, USA (Type of address: Service of Process)
2023-03-03 2025-03-08 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-03-03 2025-03-08 Address 1545 ATLANTIC AVENUE, SUITE 108, BROOKLYN, NY, 11213, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
250308000034 2025-03-08 BIENNIAL STATEMENT 2025-03-08
230303000063 2023-03-03 BIENNIAL STATEMENT 2023-03-01
211117000830 2021-11-17 BIENNIAL STATEMENT 2021-11-17
990310000633 1999-03-10 CERTIFICATE OF INCORPORATION 1999-03-10

USAspending Awards / Financial Assistance

Date:
2020-04-29
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
2000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$71,900
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$71,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$72,455.23
Servicing Lender:
Citibank, N.A.
Use of Proceeds:
Payroll: $71,900
Jobs Reported:
3
Initial Approval Amount:
$71,900
Date Approved:
2021-01-31
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$71,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$72,888.62
Servicing Lender:
Citibank, N.A.
Use of Proceeds:
Payroll: $71,899

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Date of last update: 31 Mar 2025

Sources: New York Secretary of State