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BASRI M.D. DIABETES RELIEF, P.C.

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Company Details

Name: BASRI M.D. DIABETES RELIEF, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 07 Nov 2017 (8 years ago)
Entity Number: 5230963
ZIP code: 10941
County: Orange
Place of Formation: New York
Address: 262 CRYSTAL RUN ROAD, SUITE 2, MIDDLETOWN, NY, United States, 10941

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 262 CRYSTAL RUN ROAD, SUITE 2, MIDDLETOWN, NY, United States, 10941

National Provider Identifier

NPI Number:
1730691171

Authorized Person:

Name:
DEANE WALLACE
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
207RE0101X - Endocrinology, Diabetes & Metabolism Physician
Is Primary:
Yes

Contacts:

Fax:
9165501238

Filings

Filing Number Date Filed Type Effective Date
171107000504 2017-11-07 CERTIFICATE OF INCORPORATION 2017-11-07

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Date of last update: 24 Mar 2025

Sources: New York Secretary of State