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REGINALD M. ROUSSEAU, MD, P.C.

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Company Details

Name: REGINALD M. ROUSSEAU, MD, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 08 Feb 2021 (4 years ago)
Entity Number: 5936083
ZIP code: 11706
County: Suffolk
Place of Formation: New York
Address: 340 Howells Rd, Suite 2B, Bay Shore, NY, United States, 11706

Contact Details

Phone +1 833-547-7463

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
REGINALD M ROUSSEAU, MD, PC DOS Process Agent 340 Howells Rd, Suite 2B, Bay Shore, NY, United States, 11706

Chief Executive Officer

Name Role Address
REGINALD ROUSSEAU Chief Executive Officer 100 MOTOR PKWAY, SUITE LL8, HAUPPAUGE, NY, United States, 11788

National Provider Identifier

NPI Number:
1568047967
Certification Date:
2023-03-09

Authorized Person:

Name:
REGINALD M ROUSSEAU
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207LP2900X - Pain Medicine (Anesthesiology) Physician
Is Primary:
No
Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6312485583
Fax:
6312475583

History

Start date End date Type Value
2021-02-08 2024-06-28 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2021-02-08 2024-06-28 Address 1175 MONTAUK HIGHWAY, SUITE 6, WEST ISLIP, NY, 11795, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240628000646 2024-06-28 BIENNIAL STATEMENT 2024-06-28
210208000132 2021-02-08 CERTIFICATE OF INCORPORATION 2021-02-08

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State