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M. BASTAWROS, PHYSICIAN, P.C.

Company Details

Name: M. BASTAWROS, PHYSICIAN, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 20 Sep 2013 (12 years ago)
Entity Number: 4461834
ZIP code: 10305
County: Richmond
Place of Formation: New York
Address: 314 SEAVIEW AVENUE, STATEN ISLAND, NY, United States, 10305

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 314 SEAVIEW AVENUE, STATEN ISLAND, NY, United States, 10305

National Provider Identifier

NPI Number:
1720495328

Authorized Person:

Name:
DR. MARY N BASTAWROS
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
302F00000X - Exclusive Provider Organization
Is Primary:
Yes

Contacts:

Fax:
7186683420

Filings

Filing Number Date Filed Type Effective Date
130920000663 2013-09-20 CERTIFICATE OF INCORPORATION 2013-09-20

Date of last update: 26 Mar 2025

Sources: New York Secretary of State