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GREAT LAKES PHYSICIAN PRACTICE, P.C.

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Company Details

Name: GREAT LAKES PHYSICIAN PRACTICE, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 16 Oct 2013 (12 years ago)
Entity Number: 4473747
ZIP code: 12207
County: Chautauqua
Place of Formation: New York
Address: 80 STATE STREET, ALBANY, NY, United States, 12207

Contact Details

Phone +1 716-934-3641

Phone +1 814-362-8415

Phone +1 716-945-5500

Phone +1 716-679-2233

Phone +1 716-483-0803

Phone +1 716-483-6700

Phone +1 814-456-8980

Phone +1 716-372-0582

Phone +1 716-483-5306

Phone +1 716-366-7150

Phone +1 716-366-9008

Phone +1 814-877-8000

Phone +1 716-296-5543

Phone +1 716-549-7777

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
CORPORATION SERVICE COMPANY DOS Process Agent 80 STATE STREET, ALBANY, NY, United States, 12207

National Provider Identifier

NPI Number:
1548668585

Authorized Person:

Name:
MARK T EHALT
Role:
DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
7169347443

History

Start date End date Type Value
2013-10-16 2025-05-02 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
170516000394 2017-05-16 ERRONEOUS ENTRY 2017-05-16
DP-2241583 2016-10-26 DISSOLUTION BY PROCLAMATION 2016-10-26
131016000794 2013-10-16 CERTIFICATE OF INCORPORATION 2013-10-16

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Date of last update: 26 Mar 2025

Sources: New York Secretary of State