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PM PEDIATRICS OF SELDEN, PLLC

Company Details

Name: PM PEDIATRICS OF SELDEN, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 27 Apr 2009 (16 years ago)
Entity Number: 3803234
ZIP code: 11042
County: Suffolk
Place of Formation: New York
Address: One Hollow Lane, Suite 301, Lake Success, NY, United States, 11042

Contact Details

Phone +1 631-667-4767

Phone +1 516-248-5437

Phone +1 631-696-5437

Phone +1 516-763-4764

Phone +1 516-541-5437

Phone +1 631-499-5437

DOS Process Agent

Name Role Address
PM PEDIATRICS OF SELDEN, PLLC DOS Process Agent One Hollow Lane, Suite 301, Lake Success, NY, United States, 11042

National Provider Identifier

NPI Number:
1902143886
Certification Date:
2021-02-02

Authorized Person:

Name:
MARLENA SIMPSON
Role:
DIRECTOR, CREDENTIALING/ENROLLMENT
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes
Selected Taxonomy:
261QU0200X - Urgent Care Clinic/Center
Is Primary:
No

Contacts:

Fax:
5168690655
Fax:
6316982049

History

Start date End date Type Value
2023-05-25 2025-04-04 Address One Hollow Lane, Suite 301, Lake Success, NY, 11042, USA (Type of address: Service of Process)
2022-08-25 2023-05-25 Address 80 STATE STREET, ALBANY, NY, 12207, 2543, USA (Type of address: Service of Process)
2013-04-22 2022-08-25 Address ONE HOLLOW LANE, SUITE 301, LAKE SUCCESS, NY, 11042, USA (Type of address: Service of Process)
2009-04-27 2013-04-22 Address 1 BRIARCLIFF DRIVE, PORT WASHINGTON, NY, 11050, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
250404001265 2025-04-04 BIENNIAL STATEMENT 2025-04-04
230525003476 2023-05-25 BIENNIAL STATEMENT 2023-04-01
220825000048 2022-08-24 CERTIFICATE OF CHANGE BY ENTITY 2022-08-24
210428060207 2021-04-28 BIENNIAL STATEMENT 2021-04-01
200310060221 2020-03-10 BIENNIAL STATEMENT 2019-04-01

Date of last update: 27 Mar 2025

Sources: New York Secretary of State