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WAVERLY MEDICAL ASSOCIATES, LLC

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Company Details

Name: WAVERLY MEDICAL ASSOCIATES, LLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 01 Mar 2016 (9 years ago)
Entity Number: 4904672
ZIP code: 14892
County: Tioga
Place of Formation: New York
Address: 80 WILLIAM DONNELLY IND. PKWY., SUITE 2, WAVERLY, NY, United States, 14892

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 80 WILLIAM DONNELLY IND. PKWY., SUITE 2, WAVERLY, NY, United States, 14892

National Provider Identifier

NPI Number:
1457757486

Authorized Person:

Name:
DR. VICTOR OMAMODE IDAHOSA
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6079481030

Filings

Filing Number Date Filed Type Effective Date
170724000341 2017-07-24 CERTIFICATE OF PUBLICATION 2017-07-24
160301000438 2016-03-01 ARTICLES OF ORGANIZATION 2016-03-01

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Date of last update: 25 Mar 2025

Sources: New York Secretary of State