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DEER PARK MEDICAL P.C.

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Company Details

Name: DEER PARK MEDICAL P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 28 Mar 2019 (6 years ago)
Entity Number: 5523291
ZIP code: 11729
County: Suffolk
Place of Formation: New York
Address: 2103 DEER PARK AVE., DEER PARK, NY, United States, 11729

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 2103 DEER PARK AVE., DEER PARK, NY, United States, 11729

National Provider Identifier

NPI Number:
1285264192
Certification Date:
2020-01-20

Authorized Person:

Name:
WILLIAM ROBERTO LOPEZ
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
2085B0100X - Body Imaging Physician
Is Primary:
Yes

Contacts:

Fax:
6319185724

Filings

Filing Number Date Filed Type Effective Date
190328000682 2019-03-28 CERTIFICATE OF INCORPORATION 2019-03-28

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Date of last update: 23 Mar 2025

Sources: New York Secretary of State