INNOVATION SPINE MEDICAL, P.C.

Company Details

Name:	INNOVATION SPINE MEDICAL, P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	30 Aug 2010 (15 years ago)
Entity Number:	3990075
ZIP code:	11374
County:	Queens
Place of Formation:	New York
Address:	97-01 66th Avenue, Rego Park, NY, United States, 11374

Shares Details

Shares issued 10

Share Par Value 0.01

Type PAR VALUE

Name	Role	Address
DMITRIY FUZAYLOV, MD	DOS Process Agent	97-01 66th Avenue, Rego Park, NY, United States, 11374

Name	Role	Address
DMITRIY FUZAYLOV, MD	Chief Executive Officer	97-01 66TH AVENUE, REGO PARK, NY, United States, 11374

Start date	End date	Type	Value
2024-09-17	2024-09-17	Address	4 WEBER AVE, MALVERNE, NY, 11565, USA (Type of address: Chief Executive Officer)
2010-08-30	2024-09-17	Shares	Share type: PAR VALUE, Number of shares: 10, Par value: 0.01
2010-08-30	2024-09-17	Address	7014 13TH AVENUE, SUITE 202, BROOKLYN, NY, 11228, USA (Type of address: Service of Process)

Filing Number	Date Filed	Type	Effective Date
240917000933	2024-09-17	BIENNIAL STATEMENT	2024-09-17
220204002057	2022-02-04	BIENNIAL STATEMENT	2022-02-04
100830000029	2010-08-30	CERTIFICATE OF INCORPORATION	2010-08-30

Loan Number

Loan Funded Date

SBA Origination Office Code

Loan Delivery Method

Borrower Street Address

1554378602

2021-03-13

0235

PPS

4 Weber Ave, Malverne, NY, 11565-1742

Loan Status Date	2022-05-19
Loan Status	Paid in Full
Loan Maturity in Months	60
SBA Guaranty Percentage	100
Loan Approval Amount (at origination)	141465
Loan Approval Amount (current)	141465
Undisbursed Amount	0
Franchise Name	-
Lender Location ID	48270
Servicing Lender Name	JPMorgan Chase Bank, National Association
Servicing Lender Address	1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator	U
Hubzone	N
LMI	N
Business Age Description	Existing or more than 2 years old
Project Address	Malverne, NASSAU, NY, 11565-1742
Project Congressional District	NY-04
Number of Employees	13
NAICS code	621498
Borrower Race	White
Borrower Ethnicity	Not Hispanic or Latino
Business Type	Subchapter S Corporation
Originating Lender ID	48270
Originating Lender Name	JPMorgan Chase Bank, National Association
Originating Lender Address	COLUMBUS, OH
Gender	Male Owned
Veteran	Non-Veteran
Forgiveness Amount	142924.53
Forgiveness Paid Date	2022-03-31

8162797105

2020-04-15

0235

PPP

4 WEBER AVE, MALVERNE, NY, 11565

Loan Status Date	2021-04-22
Loan Status	Paid in Full
Loan Maturity in Months	24
SBA Guaranty Percentage	100
Loan Approval Amount (at origination)	146632
Loan Approval Amount (current)	136632
Undisbursed Amount	0
Franchise Name	-
Lender Location ID	48270
Servicing Lender Name	JPMorgan Chase Bank, National Association
Servicing Lender Address	1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator	U
Hubzone	N
LMI	N
Business Age Description	Existing or more than 2 years old
Project Address	MALVERNE, NASSAU, NY, 11565-0001
Project Congressional District	NY-04
Number of Employees	14
NAICS code	621498
Borrower Race	White
Borrower Ethnicity	Not Hispanic or Latino
Business Type	Subchapter S Corporation
Originating Lender ID	194093
Originating Lender Name	JPMorgan Chase Bank, National Association
Originating Lender Address	CHICAGO, IL
Gender	Male Owned
Veteran	Non-Veteran
Forgiveness Amount	137904.04
Forgiveness Paid Date	2021-03-25

Date of last update: 27 Mar 2025