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ANDREW FAGELMAN, M.D. PLLC

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Company Details

Name: ANDREW FAGELMAN, M.D. PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 06 May 2004 (21 years ago)
Entity Number: 3050027
ZIP code: 10280
County: New York
Place of Formation: New York
Address: 21 SOUTH END AVE #424, NEW YORK, NY, United States, 10280

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 21 SOUTH END AVE #424, NEW YORK, NY, United States, 10280

National Provider Identifier

NPI Number:
1437570744
Certification Date:
2023-12-11

Authorized Person:

Name:
MR. ANDREW FAGELMAN
Role:
DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2123438549

Form 5500 Series

Employer Identification Number (EIN):
200553992
Plan Year:
2024
Number Of Participants:
15
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
11
Sponsors Telephone Number:

History

Start date End date Type Value
2008-05-16 2024-03-15 Address 21 SOUTH END AVE #424, NEW YORK, NY, 10280, USA (Type of address: Service of Process)
2004-05-06 2008-05-16 Address 21 SOUTH END AVE PH1BB, NEW YORK, NY, 10280, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240315000824 2024-03-15 BIENNIAL STATEMENT 2024-03-15
200729060438 2020-07-29 BIENNIAL STATEMENT 2020-05-01
120509006001 2012-05-09 BIENNIAL STATEMENT 2012-05-01
100601002326 2010-06-01 BIENNIAL STATEMENT 2010-05-01
080516002259 2008-05-16 BIENNIAL STATEMENT 2008-05-01

Paycheck Protection Program

Jobs Reported:
11
Initial Approval Amount:
$149,077
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$149,077
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$150,383.74
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $111,808
Utilities: $1,000
Rent: $33,069
Healthcare: $1200
Debt Interest: $2,000
Jobs Reported:
10
Initial Approval Amount:
$149,077
Date Approved:
2021-02-03
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$149,077
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$150,034.74
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $149,075
Utilities: $1

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State