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210 MINEOLA MEDICAL, P.C.

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Company Details

Name: 210 MINEOLA MEDICAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 05 Sep 2018 (7 years ago)
Entity Number: 5404899
ZIP code: 11501
County: Nassau
Place of Formation: New York
Address: 210 OLD COUNTRY ROAD, MINEOLA, NY, United States, 11501

Contact Details

Phone +1 516-871-3003

Phone +1 929-219-0990

Phone +1 929-207-9977

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 210 OLD COUNTRY ROAD, MINEOLA, NY, United States, 11501

National Provider Identifier

NPI Number:
1821566969

Authorized Person:

Name:
IRENA MUSHEEV
Role:
CREDENTIALING COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
180905000845 2018-09-05 CERTIFICATE OF INCORPORATION 2018-09-05

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State