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SOUTH SHORE WOMENS CARE PLLC

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Company Details

Name: SOUTH SHORE WOMENS CARE PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 12 Mar 2019 (6 years ago)
Entity Number: 5511685
ZIP code: 11746
County: Suffolk
Place of Formation: New York
Address: 21 COBBLERS LANE, DIX HILLS, NY, United States, 11746

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 21 COBBLERS LANE, DIX HILLS, NY, United States, 11746

National Provider Identifier

NPI Number:
1174190326
Certification Date:
2021-06-07

Authorized Person:

Name:
LARISSA FOMITCHEVA
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207V00000X - Obstetrics & Gynecology Physician
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
834471580
Plan Year:
2023
Number Of Participants:
8
Sponsors Telephone Number:

Filings

Filing Number Date Filed Type Effective Date
190312000619 2019-03-12 ARTICLES OF ORGANIZATION 2019-03-12

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State