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HEIDI FYRBERG PHYSICIAN ASSISTANT P.C.

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Company Details

Name: HEIDI FYRBERG PHYSICIAN ASSISTANT P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 18 Mar 2019 (6 years ago)
Entity Number: 5515449
ZIP code: 11724
County: Suffolk
Place of Formation: New York
Address: 20 DONOVAN DRIVE, COLD SPRING HARBOR, NY, United States, 11724

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 20 DONOVAN DRIVE, COLD SPRING HARBOR, NY, United States, 11724

National Provider Identifier

NPI Number:
1770054710

Authorized Person:

Name:
HEIDI FYRBERG-COHEN
Role:
PHYSICIAN ASSISTANT
Phone:

Taxonomy:

Selected Taxonomy:
363AS0400X - Surgical Physician Assistant
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
190318000346 2019-03-18 CERTIFICATE OF INCORPORATION 2019-03-18

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State