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ANDREW J. SIEDLECKI, M.D., P.C.

ANDREW J. SIEDLECKI, M.D., P.C.

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Company Details

Name:	ANDREW J. SIEDLECKI, M.D., P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	13 May 2004 (21 years ago)
Entity Number:	3053015
ZIP code:	14202
County:	Erie
Place of Formation:	New York
Address:	200 DELAWARE AVENUE, THE AVANT BUILDING, BUFFALO, NY, United States, 14202
Principal Address:	170 MAPLE RD, WILLIAMSVILLE, NY, United States, 14221

Contact Details

Phone +1 716-634-8500

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name	Role	Address
ANDREW J. SIEDLECKI, M.D.	Chief Executive Officer	PO BOX 1068, GETZVILLE, NY, United States, 14068

DOS Process Agent

Name	Role	Address
BARCLAY DAMON, LLP- CHRISTOPHER T. GREENE	DOS Process Agent	200 DELAWARE AVENUE, THE AVANT BUILDING, BUFFALO, NY, United States, 14202

National Provider Identifier

NPI Number:

1689884488

Certification Date:

2025-01-13

Link:

View on NPI website

Authorized Person:

Name:

NICOLE BEACH

Role:

ADMINISTRATOR

Phone:

7166348500

Taxonomy:

Selected Taxonomy:

207W00000X - Ophthalmology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 716-634-8500

Form 5500 Series

Employer Identification Number (EIN):

161386911

Plan Year:

2023

Number Of Participants:

31

Sponsors Telephone Number:

7166348500

File:

Plan Year:

2022

Number Of Participants:

27

Sponsors Telephone Number:

7166348500

File:

Plan Year:

2021

Number Of Participants:

27

Sponsors Telephone Number:

7166348500

File:

Plan Year:

2020

Number Of Participants:

23

Sponsors Telephone Number:

7166348500

File:

Plan Year:

2019

Number Of Participants:

20

Sponsors Telephone Number:

7166348500

File:

History

Start date	End date	Type	Value
2012-05-14	2016-05-13	Address	461 MOUNTAIN VIEW DRIVE, LEWISTON, NY, 14092, USA (Type of address: Principal Executive Office)
2006-05-24	2012-05-14	Address	6945 LEXINGTON CT, EAST AMHERST, NY, 14051, USA (Type of address: Principal Executive Office)
2006-05-24	2016-05-13	Address	17 COURT STREET SUITE 600, BUFFALO, NY, 14202, USA (Type of address: Service of Process)
2004-05-13	2006-05-24	Address	17 COURT STREET SUITE 600, BUFFALO, NY, 14202, USA (Type of address: Service of Process)

Filings

Filing Number	Date Filed	Type	Effective Date
200504062274	2020-05-04	BIENNIAL STATEMENT	2020-05-01
180503006771	2018-05-03	BIENNIAL STATEMENT	2018-05-01
160513006860	2016-05-13	BIENNIAL STATEMENT	2016-05-01
120514006160	2012-05-14	BIENNIAL STATEMENT	2012-05-01
110527000001	2011-05-27	ERRONEOUS ENTRY	2011-05-27

Paycheck Protection Program

Jobs Reported:

21

Initial Approval Amount:

$145,400

Date Approved:

2021-01-30

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$261,687

Race:

White

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Unanswered

Forgiveness Amount:

$264,389.9

Servicing Lender:

Citizens Bank, National Association

Use of Proceeds:

Payroll: $261,687

Jobs Reported:

19

Initial Approval Amount:

$145,400

Date Approved:

2020-04-16

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$145,400

Race:

White

Ethnicity:

Not Hispanic or Latino

Gender:

Male Owned

Veteran:

Unanswered

Forgiveness Amount:

$146,734.49

Servicing Lender:

Citizens Bank, National Association

Use of Proceeds:

Payroll: $145,400

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State