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JASON HALEGOUA, M.D., P.C.

Company Details

Name: JASON HALEGOUA, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 09 Oct 2009 (16 years ago)
Entity Number: 3865654
ZIP code: 11720
County: Suffolk
Place of Formation: New York
Address: 11 Lily Drive, South Setauket, NY, United States, 11720

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
JASON HALEGOUA Chief Executive Officer 11 LILY DRIVE, SOUTH SETAUKET, NY, United States, 11720

DOS Process Agent

Name Role Address
JASON HALEGOUA, M.D., P.C. DOS Process Agent 11 Lily Drive, South Setauket, NY, United States, 11720

National Provider Identifier

NPI Number:
1750619581
Certification Date:
2024-03-19

Authorized Person:

Name:
DR. JASON HALEGOUA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
6316759778

Form 5500 Series

Employer Identification Number (EIN):
270611895
Plan Year:
2014
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
18
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2011
Number Of Participants:
13
Sponsors Telephone Number:

History

Start date End date Type Value
2024-03-01 2024-03-01 Address 2799 ROUTE 112, STE 11, MEDFORD, NY, 11763, USA (Type of address: Chief Executive Officer)
2016-07-27 2024-03-01 Address 2799 ROUTE 112, STE 11, MEDFORD, NY, 11763, USA (Type of address: Service of Process)
2016-07-27 2024-03-01 Address 2799 ROUTE 112, STE 11, MEDFORD, NY, 11763, USA (Type of address: Chief Executive Officer)
2012-01-23 2016-07-27 Address 69 WINTHROP RD, PLAINVIEW, NY, 11803, USA (Type of address: Principal Executive Office)
2012-01-23 2016-07-27 Address 3241 RTE 112, STE 7, MEDFORD, NY, 11763, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
240301062511 2024-03-01 BIENNIAL STATEMENT 2024-03-01
160727006152 2016-07-27 BIENNIAL STATEMENT 2015-10-01
120123002054 2012-01-23 BIENNIAL STATEMENT 2011-10-01
091009000230 2009-10-09 CERTIFICATE OF INCORPORATION 2009-10-09

Date of last update: 27 Mar 2025

Sources: New York Secretary of State