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  5. EVERGREEN FAMILY MEDICAL SERVICES, P.C.

EVERGREEN FAMILY MEDICAL SERVICES, P.C.

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Company Details

Name: EVERGREEN FAMILY MEDICAL SERVICES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 14 Nov 2005 (20 years ago)
Entity Number: 3280645
ZIP code: 11220
County: Kings
Place of Formation: New York
Address: 743 58TH STREET, BROOKLYN, NY, United States, 11220

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
RAYMOND CHAN Chief Executive Officer 743 58TH STREET, BROOKLYN, NY, United States, 11220

DOS Process Agent

Name Role Address
RAYMOND CHAN DOS Process Agent 743 58TH STREET, BROOKLYN, NY, United States, 11220

National Provider Identifier

NPI Number:
1891761243
Link:
View on NPI website

Authorized Person:

Name:
RAYMOND CHAN
Role:
MEDICAL DIRETOR
Phone:
7187650088

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Phone:
+1 718-765-0088
Fax:
7185678208

Form 5500 Series

Employer Identification Number (EIN):
134315515
Plan Year:
2022
Number Of Participants:
4
Sponsors Telephone Number:
7187650088
File:
View File
Plan Year:
2022
Number Of Participants:
4
Sponsors Telephone Number:
7187650088
File:
View File
Plan Year:
2021
Number Of Participants:
4
Sponsors Telephone Number:
7187650088
File:
View File
Plan Year:
2021
Number Of Participants:
2
Sponsors Telephone Number:
7187650088
File:
View File
Plan Year:
2015
Number Of Participants:
3
Sponsors Telephone Number:
7187650088
File:
View File

Filings

Filing Number Date Filed Type Effective Date
220628003151 2022-06-28 BIENNIAL STATEMENT 2021-11-01
051114000798 2005-11-14 CERTIFICATE OF INCORPORATION 2005-11-14

USAspending Awards / Financial Assistance

Date:
2021-02-11
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
102870.00
Total Face Value Of Loan:
102870.00
Date:
2020-05-02
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
94935.00
Total Face Value Of Loan:
94935.00

Paycheck Protection Program

Jobs Reported:
9
Initial Approval Amount:
$102,870
Date Approved:
2021-02-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$102,870
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$103,575.69
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $102,869
Jobs Reported:
15
Initial Approval Amount:
$94,935
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$94,935
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$95,888.62
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $94,935

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State

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