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ELYSE S. RAFAL, M.D., P.C.

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Company Details

Name: ELYSE S. RAFAL, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 11 Jul 2000 (25 years ago)
Entity Number: 2530127
ZIP code: 11790
County: Suffolk
Place of Formation: New York
Address: 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, United States, 11790

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
ELYSE S. RAFAL, MD Chief Executive Officer 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, United States, 11790

DOS Process Agent

Name Role Address
ELYSE S. RAFAL, MD DOS Process Agent 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, United States, 11790

National Provider Identifier

NPI Number:
1699025635

Authorized Person:

Name:
DR. ELYSE S RAFAL
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
6316891153

Form 5500 Series

Employer Identification Number (EIN):
113555219
Plan Year:
2023
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
16
Sponsors Telephone Number:

History

Start date End date Type Value
2024-07-25 2024-07-25 Address 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, 11790, USA (Type of address: Chief Executive Officer)
2023-05-03 2024-07-25 Address 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, 11790, USA (Type of address: Chief Executive Officer)
2023-05-03 2024-07-25 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-05-03 2023-05-03 Address 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, 11790, USA (Type of address: Chief Executive Officer)
2023-05-03 2024-07-25 Address 2500 ROUTE 347, BLDG 22A, STONY BROOK, NY, 11790, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240725002972 2024-07-25 BIENNIAL STATEMENT 2024-07-25
230503002161 2023-05-03 BIENNIAL STATEMENT 2022-07-01
200512000481 2020-05-12 CERTIFICATE OF CHANGE 2020-05-12
180702006869 2018-07-02 BIENNIAL STATEMENT 2018-07-01
140702006989 2014-07-02 BIENNIAL STATEMENT 2014-07-01

Paycheck Protection Program

Jobs Reported:
7
Initial Approval Amount:
$75,900
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$75,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$76,840.32
Servicing Lender:
Citibank, N.A.
Use of Proceeds:
Payroll: $75,900

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State