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11 MEDICAL DRIVE WELLNESS PLLC

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Company Details

Name: 11 MEDICAL DRIVE WELLNESS PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 05 Apr 2017 (8 years ago)
Entity Number: 5115311
ZIP code: 11776
County: Suffolk
Place of Formation: New York
Address: 11 MEDICAL DRIVE, PORT JEFFERSON STA, NY, United States, 11776

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 11 MEDICAL DRIVE, PORT JEFFERSON STA, NY, United States, 11776

National Provider Identifier

NPI Number:
1902332588

Authorized Person:

Name:
LAURA ROY
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
207PE0004X - Emergency Medical Services (Emergency Medicine) Physician
Is Primary:
Yes

Contacts:

Fax:
6318495824

Filings

Filing Number Date Filed Type Effective Date
171027000070 2017-10-27 CERTIFICATE OF PUBLICATION 2017-10-27
170405000584 2017-04-05 ARTICLES OF ORGANIZATION 2017-04-05

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Date of last update: 24 Mar 2025

Sources: New York Secretary of State