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SOUTHERN TIER PEDIATRICS PRACTICE, P.C.

SOUTHERN TIER PEDIATRICS PRACTICE, P.C.

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Company Details

Name:	SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	30 Jun 1999 (26 years ago)
Entity Number:	2393815
ZIP code:	14701
County:	Chautauqua
Place of Formation:	New York
Principal Address:	1684 FOOTE AVE EXT, JAMESTOWN, NY, United States, 14701
Address:	1684 Foote ave ext, JAMESTOWN, NY, United States, 14701

Contact Details

Phone +1 716-661-9730

Phone +1 716-358-5437

Shares Details

Shares issued 200

Share Par Value 100

Type PAR VALUE

DOS Process Agent

Name	Role	Address
SOUTHERN TIER PEDIATRICS PRACTICE, P.C.	DOS Process Agent	1684 Foote ave ext, JAMESTOWN, NY, United States, 14701

Chief Executive Officer

Name	Role	Address
TARIQ M. KHAN	Chief Executive Officer	1684 FOOTE AVE EXT, JAMESTOWN, NY, United States, 14701

National Provider Identifier

NPI Number:

1710902200

Link:

View on NPI website

Authorized Person:

Name:

TARIQ M KHAN

Role:

PRESIDENT

Phone:

7166619730

Taxonomy:

Selected Taxonomy:

2080A0000X - Pediatric Adolescent Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 716-661-9730

Fax:

7166619732

Form 5500 Series

Employer Identification Number (EIN):

161570481

Plan Year:

2016

Number Of Participants:

23

Sponsors Telephone Number:

7166619730

File:

Plan Year:

2015

Number Of Participants:

21

Sponsors Telephone Number:

7166619730

File:

Plan Year:

2014

Number Of Participants:

18

Sponsors Telephone Number:

7166619730

File:

Plan Year:

2013

Number Of Participants:

19

Sponsors Telephone Number:

7166619730

File:

History

Start date	End date	Type	Value
2025-06-01	2025-06-01	Address	1684 FOOTE AVE EXT, JAMESTOWN, NY, 14701, USA (Type of address: Chief Executive Officer)
2023-09-03	2025-06-01	Address	1684 FOOTE AVE EXT, JAMESTOWN, NY, 14701, USA (Type of address: Chief Executive Officer)
2023-09-03	2025-06-01	Shares	Share type: PAR VALUE, Number of shares: 200, Par value: 100
2023-09-03	2023-09-03	Address	1684 FOOTE AVE EXT, JAMESTOWN, NY, 14701, USA (Type of address: Chief Executive Officer)
2023-09-03	2025-06-01	Address	1684 Foote ave ext, JAMESTOWN, NY, 14701, USA (Type of address: Service of Process)

Filings

Filing Number	Date Filed	Type	Effective Date
250601042913	2025-06-01	BIENNIAL STATEMENT	2025-06-01
230903000483	2023-09-03	BIENNIAL STATEMENT	2023-06-01
210611060157	2021-06-11	BIENNIAL STATEMENT	2021-06-01
190605060371	2019-06-05	BIENNIAL STATEMENT	2019-06-01
170626006002	2017-06-26	BIENNIAL STATEMENT	2017-06-01

USAspending Awards / Financial Assistance

Date:

2020-04-13

Link:

View on USAspending

Awarding Agency Name:

Small Business Administration

Transaction Description:

TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.

Obligated Amount:

0.00

Face Value Of Loan:

239565.00

Total Face Value Of Loan:

239565.00

Paycheck Protection Program

Jobs Reported:

25

Initial Approval Amount:

$242,059.98

Date Approved:

2021-01-27

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$242,059.98

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$243,810.77

Servicing Lender:

Northwest Bank

Use of Proceeds:

Payroll: $242,057.98
Utilities: $1

Jobs Reported:

24

Initial Approval Amount:

$239,565

Date Approved:

2020-04-13

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$239,565

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Male Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$240,985.75

Servicing Lender:

Northwest Bank

Use of Proceeds:

Payroll: $239,565

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Date of last update: 31 Mar 2025

Sources: New York Secretary of State