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EVERNORTH MEDICAL CARE PROVIDERS-NEW YORK PROFESSIONAL CORPORATION

Company Details

Name: EVERNORTH MEDICAL CARE PROVIDERS-NEW YORK PROFESSIONAL CORPORATION
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 19 Sep 2014 (11 years ago)
Entity Number: 4638905
ZIP code: 10005
County: New York
Place of Formation: New York
Address: 28 liberty street, NEW YORK, NY, United States, 10005
Principal Address: 555 Broadhollow Road, Suite 305, Melville, NY, United States, 11747

Shares Details

Shares issued 100

Share Par Value 0.01

Type PAR VALUE

DOS Process Agent

Name Role Address
C/O C T CORPORATION SYSTEM DOS Process Agent 28 liberty street, NEW YORK, NY, United States, 10005

Agent

Name Role Address
c t corporation system Agent 28 liberty street, NEW YORK, NY, 10005

Chief Executive Officer

Name Role Address
SHANNON ALSOP, DO Chief Executive Officer 555 BROADHOLLOW ROAD, SUITE 305, MELVILLE, NY, United States, 11747

National Provider Identifier

NPI Number:
1205234291
Certification Date:
2024-02-13

Authorized Person:

Name:
GRACE BLUE
Role:
CREDENTIALING SR. MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes
Selected Taxonomy:
207QA0505X - Adult Medicine Physician
Is Primary:
No
Selected Taxonomy:
207QH0002X - Hospice and Palliative Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
No
Selected Taxonomy:
207RH0002X - Hospice and Palliative Medicine (Internal Medicine) Physician
Is Primary:
No

Contacts:

Fax:
3125644059

History

Start date End date Type Value
2024-09-02 2024-09-02 Address 555 BROADHOLLOW ROAD, SUITE 305, MELVILLE, NY, 11747, USA (Type of address: Chief Executive Officer)
2024-09-02 2024-09-02 Address 1340 SOUTH DAMEN AVE, SUITE 400, CHICAGO, IL, 60608, USA (Type of address: Chief Executive Officer)
2024-09-02 2024-09-02 Address 500 GREAT CIRCLE ROAD, NASHVILLE, TN, 37228, USA (Type of address: Chief Executive Officer)
2024-01-29 2024-09-02 Address 1340 SOUTH DAMEN AVE, SUITE 400, CHICAGO, IL, 60608, USA (Type of address: Chief Executive Officer)
2024-01-29 2024-01-29 Address 1340 SOUTH DAMEN AVE, SUITE 400, CHICAGO, IL, 60608, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
240902000456 2024-09-02 BIENNIAL STATEMENT 2024-09-02
240129001567 2024-01-26 CERTIFICATE OF AMENDMENT 2024-01-26
220915001875 2022-09-15 BIENNIAL STATEMENT 2022-09-01
220404000629 2022-04-04 CERTIFICATE OF CHANGE BY ENTITY 2022-04-04
210517001498 2021-05-17 CERTIFICATE OF AMENDMENT 2021-05-17

Date of last update: 25 Mar 2025

Sources: New York Secretary of State