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121 MEDICAL P.C.

Company Details

Name: 121 MEDICAL P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 21 Feb 2020 (5 years ago)
Entity Number: 5713137
ZIP code: 10034
County: New York
Place of Formation: New York
Address: 5030 BROADWAY, STE 818, NEW YORK, NY, United States, 10034

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
LIDIA VIRGIL DOS Process Agent 5030 BROADWAY, STE 818, NEW YORK, NY, United States, 10034

National Provider Identifier

NPI Number:
1235762899
Certification Date:
2020-05-11

Authorized Person:

Name:
JANIL CRUZ
Role:
OFFICE MANAGER
Phone:

Taxonomy:

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

Contacts:

Filings

Filing Number Date Filed Type Effective Date
200221000221 2020-02-21 CERTIFICATE OF INCORPORATION 2020-02-21

Date of last update: 23 Mar 2025

Sources: New York Secretary of State