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CATHERINE POULOS PSYCHIATRIC NURSE PRACTITIONER, PLLC

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Company Details

Name: CATHERINE POULOS PSYCHIATRIC NURSE PRACTITIONER, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 01 May 2013 (12 years ago)
Entity Number: 4396793
ZIP code: 11946
County: Suffolk
Place of Formation: New York
Address: 332 WEST MONTAUK HIGHWAY, SUITE 5, HAMPTON BAYS, NY, United States, 11946

Agent

Name Role Address
DAWN BUSHELL CPA Agent 76 ROBERTS PATH, WADING RIVER, NY, 11792

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 332 WEST MONTAUK HIGHWAY, SUITE 5, HAMPTON BAYS, NY, United States, 11946

National Provider Identifier

NPI Number:
1457790198

Authorized Person:

Name:
MS. CATHERINE POULOS
Role:
NURSE PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
6318222833

History

Start date End date Type Value
2019-08-05 2021-07-26 Address 332 WEST MONTAUK HIGHWAY, SUITE 5, HAMPTON BAYS, NY, 11946, USA (Type of address: Service of Process)
2013-05-01 2019-08-05 Address 99 SANFORD PLACE, SOUTHAMPTON, NY, 11968, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210726000039 2021-07-26 CERTIFICATE OF CHANGE BY ENTITY 2021-07-26
190805000477 2019-08-05 CERTIFICATE OF CHANGE 2019-08-05
130501000446 2013-05-01 ARTICLES OF ORGANIZATION 2013-05-01

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State