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KEITH R. BRUNCKHORST, M.D., P.C.

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Company Details

Name: KEITH R. BRUNCKHORST, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 30 Jun 2004 (21 years ago)
Entity Number: 3072963
ZIP code: 10021
County: New York
Place of Formation: New York
Address: 157 EAST 72ND STREET, LOWER LEVEL, NEW YORK, NY, United States, 10021

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
KEITH R. BRUNCKHORST, M.D., P.C. DOS Process Agent 157 EAST 72ND STREET, LOWER LEVEL, NEW YORK, NY, United States, 10021

Chief Executive Officer

Name Role Address
KEITH R BRUNCKHORST MD. PC Chief Executive Officer 157 EAST 72ND STREET, LOWER LEVEL, NEW YORK, NY, United States, 10021

National Provider Identifier

NPI Number:
1346293933

Authorized Person:

Name:
DR. KEITH R BRUNCKHORST
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
2124073909

History

Start date End date Type Value
2006-05-24 2018-06-05 Address 110 E 59TH ST, SUITE 9B, NEW YORK, NY, 10022, USA (Type of address: Chief Executive Officer)
2006-05-24 2018-06-05 Address 110 E 59TH ST, SUITE 9B, NEW YORK, NY, 10022, USA (Type of address: Principal Executive Office)
2004-06-30 2018-06-05 Address SUITE 9B, 110 EAST 59TH STREET, NEW YORK, NY, 10022, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
200612060442 2020-06-12 BIENNIAL STATEMENT 2020-06-01
180605006950 2018-06-05 BIENNIAL STATEMENT 2018-06-01
160602006038 2016-06-02 BIENNIAL STATEMENT 2016-06-01
140610006797 2014-06-10 BIENNIAL STATEMENT 2014-06-01
120717002935 2012-07-17 BIENNIAL STATEMENT 2012-06-01

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State