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KEITH RYAN JACKSON, M.D., P.C.

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Company Details

Name: KEITH RYAN JACKSON, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 10 Sep 2002 (23 years ago)
Entity Number: 2809732
ZIP code: 10304
County: Richmond
Place of Formation: New York
Address: 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, United States, 10304

Contact Details

Phone +1 718-727-1331

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Agent

Name Role Address
LISA M CLEMENTI, CPA Agent 125 BAY TERRACE, STATEN ISLAND, NY, 10306

Chief Executive Officer

Name Role Address
KEITH RYAN JACKSON MD Chief Executive Officer 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, United States, 10304

DOS Process Agent

Name Role Address
KEITH RYAN JACKSON, M.D., P.C. DOS Process Agent 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, United States, 10304

National Provider Identifier

NPI Number:
1326216847

Authorized Person:

Name:
DR. KEITH RYAN JACKSON
Role:
PRESIDENT
Phone:

Taxonomy:

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

Contacts:

Fax:
7187272159

Form 5500 Series

Employer Identification Number (EIN):
030482650
Plan Year:
2024
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
8
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
8
Sponsors Telephone Number:

History

Start date End date Type Value
2024-09-01 2024-09-01 Address 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, 10304, USA (Type of address: Chief Executive Officer)
2023-03-07 2024-09-01 Address 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, 10304, USA (Type of address: Chief Executive Officer)
2023-03-07 2023-03-07 Address 11 RALPH PLACE, SUITE 209, STATEN ISLAND, NY, 10304, USA (Type of address: Chief Executive Officer)
2023-03-07 2024-09-01 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-03-07 2024-09-01 Address 125 BAY TERRACE, STATEN ISLAND, NY, 10306, USA (Type of address: Registered Agent)

Filings

Filing Number Date Filed Type Effective Date
240901035122 2024-09-01 BIENNIAL STATEMENT 2024-09-01
230307000634 2023-03-07 BIENNIAL STATEMENT 2022-09-01
160901006726 2016-09-01 BIENNIAL STATEMENT 2016-09-01
140902006979 2014-09-02 BIENNIAL STATEMENT 2014-09-01
120907006758 2012-09-07 BIENNIAL STATEMENT 2012-09-01

Paycheck Protection Program

Jobs Reported:
7
Initial Approval Amount:
$95,800
Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$95,800
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$96,731.39
Servicing Lender:
Citibank, N.A.
Use of Proceeds:
Payroll: $95,800
Jobs Reported:
7
Initial Approval Amount:
$95,800
Date Approved:
2021-02-12
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$95,800
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$96,515.84
Servicing Lender:
Citibank, N.A.
Use of Proceeds:
Payroll: $95,798
Utilities: $1

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Date of last update: 30 Mar 2025

Sources: New York Secretary of State