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PW MEDICAL PROFESSIONAL, P.C.

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Company Details

Name: PW MEDICAL PROFESSIONAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 01 May 2017 (8 years ago)
Entity Number: 5128682
ZIP code: 10168
County: New York
Place of Formation: New York
Address: 122 E. 42ND ST., 18th floor, NEW YORK, NY, United States, 10168
Principal Address: 823 Congress Ave, Suite 1200, Austin, TX, United States, 78701

Shares Details

Shares issued 100

Share Par Value 0

Type NO PAR VALUE

Agent

Name Role Address
COGENCY GLOBAL INC. Agent 122 E. 42ND ST., 18th floor, NEW YORK, NY, 10168

DOS Process Agent

Name Role Address
COGENCY GLOBAL INC. DOS Process Agent 122 E. 42ND ST., 18th floor, NEW YORK, NY, United States, 10168

Chief Executive Officer

Name Role Address
BRANTLEY TILMAN JOLLY MD Chief Executive Officer 823 CONGRESS AVE., SUITE 1200, AUSTIN, TX, United States, 78701

National Provider Identifier

NPI Number:
1255048443
Certification Date:
2022-10-31

Authorized Person:

Name:
CHRIS BISHKO
Role:
CFO
Phone:

Taxonomy:

Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2025-06-23 2025-06-23 Address 123 W. 18TH ST., NEW YORK, NY, 10011, USA (Type of address: Chief Executive Officer)
2025-06-23 2025-06-23 Address 823 CONGRESS AVE., SUITE 1200, AUSTIN, TX, 78701, USA (Type of address: Chief Executive Officer)
2025-05-02 2025-06-23 Address 123 W. 18TH ST., NEW YORK, NY, 10011, USA (Type of address: Chief Executive Officer)
2025-05-02 2025-05-02 Address 823 CONGRESS AVE., SUITE 1200, AUSTIN, TX, 78701, USA (Type of address: Chief Executive Officer)
2025-05-02 2025-05-02 Address 123 W. 18TH ST., NEW YORK, NY, 10011, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
250623004138 2025-06-23 CERTIFICATE OF AMENDMENT 2025-06-23
250502000203 2025-05-02 BIENNIAL STATEMENT 2025-05-02
240104001476 2023-12-15 CERTIFICATE OF CHANGE BY ENTITY 2023-12-15
230519001301 2023-05-19 BIENNIAL STATEMENT 2023-05-01
210526060269 2021-05-26 BIENNIAL STATEMENT 2021-05-01

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Date of last update: 24 Mar 2025

Sources: New York Secretary of State