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EXCELSIOR EMPIREHEALTH IPA, LLC

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Company Details

Name: EXCELSIOR EMPIREHEALTH IPA, LLC
Jurisdiction: New York
Legal type: DOMESTIC LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 21 Jul 2021 (4 years ago)
Entity Number: 6225004
ZIP code: 10013
County: New York
Place of Formation: New York
Address: 94 BOWERY, NEW YORK, NY, United States, 10013

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 94 BOWERY, NEW YORK, NY, United States, 10013

National Provider Identifier

NPI Number:
1932860541
Certification Date:
2022-01-05

Authorized Person:

Name:
KIKI WONG
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
207W00000X - Ophthalmology Physician
Is Primary:
No
Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
No
Selected Taxonomy:
213E00000X - Podiatrist
Is Primary:
No

Contacts:

History

Start date End date Type Value
2021-10-13 2023-08-03 Address 94 BOWERY, NEW YORK, NY, 10013, USA (Type of address: Service of Process)
2021-07-21 2021-10-13 Address 94 BOWERY, NEW YORK, NY, 10013, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
230803001673 2023-08-03 BIENNIAL STATEMENT 2023-07-01
211013003217 2021-10-13 CERTIFICATE OF PUBLICATION 2021-10-13
210721002180 2021-07-21 ARTICLES OF ORGANIZATION 2021-07-21

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Date of last update: 22 Mar 2025

Sources: New York Secretary of State