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  5. NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC

NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC

Company Details

Name: NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 03 Jul 2008 (17 years ago)
Entity Number: 3692394
ZIP code: 11746
County: Suffolk
Place of Formation: New York
Address: 109 ELMWOOD DRIVE, DIX HILLS, NY, United States, 11746

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2016 262935529 2017-10-09 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Signature of
Role Plan administrator
Date 2017-10-09
Name of individual signing PARI AMIN
Role Employer/plan sponsor
Date 2017-10-09
Name of individual signing PARI AMIN
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2015 262935529 2016-07-19 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Signature of
Role Plan administrator
Date 2016-07-19
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2014 262935529 2015-08-18 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Signature of
Role Plan administrator
Date 2015-08-18
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2013 262935529 2014-09-03 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Signature of
Role Plan administrator
Date 2014-09-03
Name of individual signing DAVID A. SERURE
Role Employer/plan sponsor
Date 2014-09-03
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2012 262935529 2013-09-28 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Signature of
Role Plan administrator
Date 2013-09-28
Name of individual signing DAVID A. SERURE
Role Employer/plan sponsor
Date 2013-09-28
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2011 262935529 2012-10-03 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Plan administrator’s name and address
Administrator’s EIN 262935529
Plan administrator’s name NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Plan administrator’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659
Administrator’s telephone number 6315434888

Signature of
Role Plan administrator
Date 2012-10-03
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2010 262935529 2011-06-29 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Plan administrator’s name and address
Administrator’s EIN 262935529
Plan administrator’s name NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Plan administrator’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659
Administrator’s telephone number 6315434888

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing DAVID A. SERURE
Role Employer/plan sponsor
Date 2011-06-29
Name of individual signing DAVID A. SERURE
N.Y. DERMATOLOGY GROUP 401(K) PLAN 2009 262935529 2010-09-20 NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 6315434888
Plan sponsor’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659

Plan administrator’s name and address
Administrator’s EIN 262935529
Plan administrator’s name NEW YORK DERMATOLOGY & MOHS SURGERY GROUP, PLLC
Plan administrator’s address 109 ELWOOD DRIVE, DIX HILLS, NY, 117465659
Administrator’s telephone number 6315434888

Signature of
Role Plan administrator
Date 2010-09-20
Name of individual signing DAVID A. SERURE

DOS Process Agent

Name Role Address
DAVID SERURE DOS Process Agent 109 ELMWOOD DRIVE, DIX HILLS, NY, United States, 11746

Filings

Filing Number Date Filed Type Effective Date
160718006437 2016-07-18 BIENNIAL STATEMENT 2016-07-01
140715006533 2014-07-15 BIENNIAL STATEMENT 2014-07-01
120807002929 2012-08-07 BIENNIAL STATEMENT 2012-07-01
100727003064 2010-07-27 BIENNIAL STATEMENT 2010-07-01
081017000775 2008-10-17 CERTIFICATE OF PUBLICATION 2008-10-17
080703000251 2008-07-03 ARTICLES OF ORGANIZATION 2008-07-03

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4778988600 2021-03-20 0202 PPS 820 2nd Ave Rm 3A, New York, NY, 10017-4534
Loan Status Date 2021-11-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 428627
Loan Approval Amount (current) 428627
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address New York, NEW YORK, NY, 10017-4534
Project Congressional District NY-12
Number of Employees 45
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 48270
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address COLUMBUS, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 430913.96
Forgiveness Paid Date 2021-10-06

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109 ELMWOOD DRIVE, DIX HILLS, NY, United States, 11746

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Date of last update: 28 Mar 2025

Sources: New York Secretary of State

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