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REVIVED MEDICAL IPA, LLC

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Company Details

Name: REVIVED MEDICAL IPA, LLC
Jurisdiction: New York
Legal type: DOMESTIC LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 04 Jun 2021 (4 years ago)
Entity Number: 6028676
ZIP code: 11230
County: Kings
Place of Formation: New York
Address: 1329 EAST 17TH STREET, UNIT 1, BROOKLYN, NY, United States, 11230

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 1329 EAST 17TH STREET, UNIT 1, BROOKLYN, NY, United States, 11230

National Provider Identifier

NPI Number:
1912644972
Certification Date:
2022-05-19

Authorized Person:

Name:
ILYA KIBLITSKY
Role:
SOLE MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
103T00000X - Psychologist
Is Primary:
No
Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
No
Selected Taxonomy:
225X00000X - Occupational Therapist
Is Primary:
No
Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2021-06-04 2021-08-16 Address 1329 EAST 17TH STREET, UNIT 1, BROOKLYN, NY, 11230, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210816002307 2021-08-14 CERTIFICATE OF PUBLICATION 2021-08-14
210604000105 2021-06-04 ARTICLES OF ORGANIZATION 2021-06-04

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State