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PSYCHIATRIC NURSE PRACTITIONER SERVICES, P.C.

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Company Details

Name: PSYCHIATRIC NURSE PRACTITIONER SERVICES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 25 Jan 2010 (16 years ago)
Entity Number: 3903520
ZIP code: 11725
County: Suffolk
Place of Formation: New York
Address: 5036 JERICHO TPKE. SUITE 203, COMMACK, NY, United States, 11725
Principal Address: 5036 JERICHO TURNPIKE, SUITE 203, COMMACK, NY, United States, 11725

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

Chief Executive Officer

Name Role Address
CHERYL MOORE Chief Executive Officer 5036 JERICHO TURNPIKE, SUITE 203, COMMACK, NY, United States, 11725

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 5036 JERICHO TPKE. SUITE 203, COMMACK, NY, United States, 11725

National Provider Identifier

NPI Number:
1124340641

Authorized Person:

Name:
CHERYL MOORE
Role:
PSYCHIATRIC NURSE PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
364SP0808X - Psychiatric/Mental Health Clinical Nurse Specialist
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
6314625258

Filings

Filing Number Date Filed Type Effective Date
120720002759 2012-07-20 BIENNIAL STATEMENT 2012-01-01
100125000100 2010-01-25 CERTIFICATE OF INCORPORATION 2010-01-25

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State