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VICTORY MEDICAL GROUP PLLC

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Company Details

Name: VICTORY MEDICAL GROUP PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 28 Jan 2010 (15 years ago)
Entity Number: 3905626
ZIP code: 10301
County: Richmond
Place of Formation: New York
Address: 220 VICTORY BOULEVARD, STATEN ISLAND, NY, United States, 10301

Contact Details

Phone +1 718-447-1080

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 220 VICTORY BOULEVARD, STATEN ISLAND, NY, United States, 10301

National Provider Identifier

NPI Number:
1912223280
Certification Date:
2020-10-08

Authorized Person:

Name:
MR. OMAR KLOBOCISTA
Role:
MEDICAL DOCTOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
7184471559

Filings

Filing Number Date Filed Type Effective Date
140108006469 2014-01-08 BIENNIAL STATEMENT 2014-01-01
120227002664 2012-02-27 BIENNIAL STATEMENT 2012-01-01
100128000474 2010-01-28 ARTICLES OF ORGANIZATION 2010-01-28

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State