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  5. BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.

BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.

Company Details

Name: BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 10 Apr 1980 (45 years ago)
Entity Number: 620736
ZIP code: 11772
County: Suffolk
Place of Formation: New York
Address: 260 PATCHOGUE-YAPHANK RD, SUITE F, E PATCHOGUE, NY, United States, 11772
Principal Address: 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, United States, 11772

Contact Details

Phone +1 631-654-7100

Phone +1 631-687-2828

Phone +1 631-654-8755

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2023 112523971 2024-02-14 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2024-02-14
Name of individual signing MOHAMMED RAHMAN
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2022 112523971 2023-02-28 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2023-02-28
Name of individual signing MOHAMMED RAHMAN
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2021 112523971 2022-03-30 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2022-03-30
Name of individual signing MOHAMMED RAHMAN
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2020 112523971 2021-03-02 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2021-03-02
Name of individual signing MOHAMMED RAHMAN
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2019 112523971 2020-04-24 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2020-04-24
Name of individual signing SUNG JO KIM
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2018 112523971 2019-05-01 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2019-05-01
Name of individual signing SUNG JO KIM
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2017 112523971 2018-04-20 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2018-04-20
Name of individual signing SUNG JO KIM
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2016 112523971 2017-04-22 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2017-04-22
Name of individual signing SUNG JO KIM
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2015 112523971 2016-05-05 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2016-05-05
Name of individual signing SUNG JO KIM
BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 401(K) PLAN 2014 112523971 2015-05-01 BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6316548755
Plan sponsor’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772

Plan administrator’s name and address
Administrator’s EIN 112523971
Plan administrator’s name BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Plan administrator’s address 260 PATCHOGUE YAPHANK ROAD, EAST PATCHOGUE, NY, 11772
Administrator’s telephone number 6316548755

Signature of
Role Plan administrator
Date 2015-05-01
Name of individual signing SUNG JO KIM

DOS Process Agent

Name Role Address
MOHAMMED S. RAHMAN DOS Process Agent 260 PATCHOGUE-YAPHANK RD, SUITE F, E PATCHOGUE, NY, United States, 11772

Chief Executive Officer

Name Role Address
MOHAMMED S. RAHMAN Chief Executive Officer 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, United States, 11772

History

Start date End date Type Value
2024-01-30 2024-11-11 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-01-30 2024-01-30 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, USA (Type of address: Chief Executive Officer)
2024-01-30 2024-01-30 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, 4886, USA (Type of address: Chief Executive Officer)
2020-07-08 2024-01-30 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, 4886, USA (Type of address: Chief Executive Officer)
2020-07-08 2024-01-30 Address 260 PATCHOGUE-YAPHANK RD, SUITE F, E PATCHOGUE, NY, 11772, USA (Type of address: Service of Process)
2000-04-12 2020-07-08 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, 4886, USA (Type of address: Chief Executive Officer)
1996-04-17 2000-04-12 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, USA (Type of address: Principal Executive Office)
1996-04-17 2020-07-08 Address 260 PATCHOGUE-YAPHANK RD, SUITE F, E PATCHOGUE, NY, 11772, USA (Type of address: Service of Process)
1996-04-17 2000-04-12 Address 260 PATCHOGUE-YAPHANK ROAD, SUITE F, EAST PATCHOGUE, NY, 11772, USA (Type of address: Chief Executive Officer)
1992-12-01 1996-04-17 Address 260 PATCHOGUE-YAPHANK RD, E. PATCHOGUE, NY, 11772, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
240130016368 2024-01-30 BIENNIAL STATEMENT 2024-01-30
200708060095 2020-07-08 BIENNIAL STATEMENT 2020-04-01
140623002188 2014-06-23 BIENNIAL STATEMENT 2014-04-01
120530002359 2012-05-30 BIENNIAL STATEMENT 2012-04-01
100423002975 2010-04-23 BIENNIAL STATEMENT 2010-04-01
080508003063 2008-05-08 BIENNIAL STATEMENT 2008-04-01
060414002898 2006-04-14 BIENNIAL STATEMENT 2006-04-01
040507002023 2004-05-07 BIENNIAL STATEMENT 2004-04-01
020327002228 2002-03-27 BIENNIAL STATEMENT 2002-04-01
011221000155 2001-12-21 CERTIFICATE OF AMENDMENT 2001-12-21

Related by officers

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Related by address

No related companies by address

Date of last update: 07 Jan 2025

Sources: New York Secretary of State

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