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LAKESHORE FAMILY MEDICINE ASSOCIATES, P.C.

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Company Details

Name: LAKESHORE FAMILY MEDICINE ASSOCIATES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 07 May 2002 (23 years ago)
Entity Number: 2763671
ZIP code: 14047
County: Erie
Place of Formation: New York
Address: 7060 ERIE ROAD, SUITE 100, DERBY, NY, United States, 14047

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
TARIQ SHEIKH MD Chief Executive Officer 7060 ERIE ROAD, DERBY, NY, United States, 14047

DOS Process Agent

Name Role Address
TARIQ SHEIKH DOS Process Agent 7060 ERIE ROAD, SUITE 100, DERBY, NY, United States, 14047

National Provider Identifier

NPI Number:
1801211826

Authorized Person:

Name:
KENNY HEINE
Role:
VP OF OPERATIONS
Phone:

Taxonomy:

Selected Taxonomy:
332900000X - Non-Pharmacy Dispensing Site
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2012-05-23 2016-06-10 Address 7060 ERIE ROAD, DERBY, NY, 14047, USA (Type of address: Chief Executive Officer)
2010-07-15 2012-05-23 Address 7008 ERIE ROAD / SUITE 8C, DERBY, NY, 14047, USA (Type of address: Service of Process)
2010-07-15 2012-05-23 Address 7060 ERIE ROAD, DERBY, NY, 14047, USA (Type of address: Principal Executive Office)
2010-07-15 2012-05-23 Address 7060 ERIE ROAD, DERBY, NY, 14047, USA (Type of address: Chief Executive Officer)
2008-06-25 2010-07-15 Address 7060 ERIE RD, DERBY, NY, 14047, USA (Type of address: Principal Executive Office)

Filings

Filing Number Date Filed Type Effective Date
200605060636 2020-06-05 BIENNIAL STATEMENT 2020-05-01
160610006165 2016-06-10 BIENNIAL STATEMENT 2016-05-01
120523006128 2012-05-23 BIENNIAL STATEMENT 2012-05-01
100715003190 2010-07-15 BIENNIAL STATEMENT 2010-05-01
080625002007 2008-06-25 BIENNIAL STATEMENT 2008-05-01

Paycheck Protection Program

Jobs Reported:
19
Initial Approval Amount:
$183,600
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$183,600
Race:
Asian
Ethnicity:
Unknown/NotStated
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$185,994.35
Servicing Lender:
Evans Bank, National Association
Use of Proceeds:
Payroll: $137,700
Utilities: $22,950
Rent: $22,950

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State