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JESSICA KURZDORFER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.

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Company Details

Name: JESSICA KURZDORFER, NURSE PRACTITIONER IN PSYCHIATRY, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 21 Jan 2021 (5 years ago)
Entity Number: 5923096
ZIP code: 14526
County: Monroe
Place of Formation: New York
Address: 1794 PENFIELD ROAD, PENFIELD, NY, United States, 14526

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 1794 PENFIELD ROAD, PENFIELD, NY, United States, 14526

National Provider Identifier

NPI Number:
1063094688
Certification Date:
2024-12-12

Authorized Person:

Name:
SEAN KURZDORFER
Role:
NURSE PRACTITIONER/PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QC1500X - Community Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0855X - Adolescent and Children Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
Yes

Contacts:

Fax:
9495774708

Filings

Filing Number Date Filed Type Effective Date
210121000255 2021-01-21 CERTIFICATE OF INCORPORATION 2021-01-21

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State