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FAN MEDICINE CONSULTANT, PLLC

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Company Details

Name: FAN MEDICINE CONSULTANT, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 23 Apr 2012 (13 years ago)
Entity Number: 4234915
ZIP code: 10304
County: Richmond
Place of Formation: New York
Address: 35 LAURIE COURT, STATEN ISLAND, NY, United States, 10304

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 35 LAURIE COURT, STATEN ISLAND, NY, United States, 10304

National Provider Identifier

NPI Number:
1780156711

Authorized Person:

Name:
MICHELLE ROSE FIORENZA
Role:
CREDENTIALIST
Phone:

Taxonomy:

Selected Taxonomy:
207L00000X - Anesthesiology Physician
Is Primary:
Yes

Contacts:

Fax:
7187859664
Fax:
7187859564

Form 5500 Series

Employer Identification Number (EIN):
462532534
Plan Year:
2020
Number Of Participants:
1
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
0
Sponsors Telephone Number:

Filings

Filing Number Date Filed Type Effective Date
200527060377 2020-05-27 BIENNIAL STATEMENT 2020-04-01
160405006897 2016-04-05 BIENNIAL STATEMENT 2016-04-01
140409006096 2014-04-09 BIENNIAL STATEMENT 2014-04-01
120810001015 2012-08-10 CERTIFICATE OF PUBLICATION 2012-08-10
120423000680 2012-04-23 ARTICLES OF ORGANIZATION 2012-04-23

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State