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SPINE, SPORTS + REHABILITATION MEDICINE, P.C.

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Company Details

Name: SPINE, SPORTS + REHABILITATION MEDICINE, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 01 Jul 2021 (4 years ago)
Entity Number: 6210203
ZIP code: 11598
County: Nassau
Place of Formation: New York
Address: 359 yale ave, WOODMERE, NY, United States, 11598

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
the corporation DOS Process Agent 359 yale ave, WOODMERE, NY, United States, 11598

National Provider Identifier

NPI Number:
1689330342
Certification Date:
2021-11-16

Authorized Person:

Name:
MICHELLE MALKIE BRUNNER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
204C00000X - Sports Medicine (Neuromusculoskeletal Medicine) Physician
Is Primary:
Yes

Contacts:

Fax:
5165318877

Filings

Filing Number Date Filed Type Effective Date
210701000080 2021-07-01 CERTIFICATE OF INCORPORATION 2021-07-01

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State