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FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC

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Company Details

Name: FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 16 Oct 2018 (7 years ago)
Entity Number: 5426589
ZIP code: 10970
County: Rockland
Place of Formation: New York
Address: 978 Rt 45, Suite 200, Pomona, NY, United States, 10970

DOS Process Agent

Name Role Address
LIGHTHOUSE BEHAVIORAL HEALTH DOS Process Agent 978 Rt 45, Suite 200, Pomona, NY, United States, 10970

National Provider Identifier

NPI Number:
1639771744
Certification Date:
2020-11-13

Authorized Person:

Name:
DR. FATIMA ODETALLA
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
220802000011 2022-08-02 BIENNIAL STATEMENT 2020-10-01
190118000714 2019-01-18 CERTIFICATE OF PUBLICATION 2019-01-18
181016000269 2018-10-16 ARTICLES OF ORGANIZATION 2018-10-16

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State