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MEDICAL GROUP OF NEW YORK, P.C.

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Company Details

Name: MEDICAL GROUP OF NEW YORK, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 17 Dec 2009 (16 years ago)
Entity Number: 3889866
ZIP code: 10005
County: New York
Place of Formation: New York
Address: 28 LIBERTY ST., NEW YORK, NY, United States, 10005
Principal Address: One CVS Drive, Woonsocket, RI, United States, 02895

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
C T CORPORATION SYSTEM DOS Process Agent 28 LIBERTY ST., NEW YORK, NY, United States, 10005

Chief Executive Officer

Name Role Address
DAVID G. FAIRCHILD M.D. Chief Executive Officer 218 FARM ROAD, SHERBORN, MA, United States, 01770

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 28 LIBERTY ST., NEW YORK, NY, 10005

Unique Entity ID

Unique Entity ID:
ZRJWJSGM5S31
CAGE Code:
8FVH1
UEI Expiration Date:
2026-02-19

Business Information

Activation Date:
2025-02-21
Initial Registration Date:
2019-12-03

National Provider Identifier

NPI Number:
1851030571
Certification Date:
2025-03-04

Authorized Person:

Name:
DEBORAH PINCINCE
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2024-04-01 2024-04-01 Address 80 WARREN STREET, #32, NEW YORK, NY, USA (Type of address: Chief Executive Officer)
2024-04-01 2024-04-01 Address 218 FARM ROAD, SHERBORN, MA, 01770, USA (Type of address: Chief Executive Officer)
2023-12-14 2024-04-01 Address 80 WARREN STREET, #32, NEW YORK, NY, 10007, USA (Type of address: Chief Executive Officer)
2023-12-14 2023-12-14 Address 218 FARM ROAD, SHERBORN, MA, 01770, USA (Type of address: Chief Executive Officer)
2023-12-14 2024-03-29 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
240401036941 2024-03-29 CERTIFICATE OF AMENDMENT 2024-03-29
231214002182 2023-12-14 BIENNIAL STATEMENT 2023-12-14
211213000453 2021-12-13 BIENNIAL STATEMENT 2021-12-13
191219060295 2019-12-19 BIENNIAL STATEMENT 2019-12-01
SR-53637 2019-01-28 CERTIFICATE OF CHANGE (BY AGENT) 2019-01-28

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State