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ELLICOTTVILLE MEDICAL, PLLC

Company Details

Name: ELLICOTTVILLE MEDICAL, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 21 Dec 2021 (3 years ago)
Entity Number: 6557428
ZIP code: 14731
County: Cattaraugus
Place of Formation: New York
Address: 5 park square p.o. box 1252, ELLICOTTVILLE, NY, United States, 14731

DOS Process Agent

Name Role Address
katelyn johnson-clark DOS Process Agent 5 park square p.o. box 1252, ELLICOTTVILLE, NY, United States, 14731

National Provider Identifier

NPI Number:
1902566748
Certification Date:
2021-12-21

Authorized Person:

Name:
DR. KATELYN JOHNSON-CLARK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Filings

Filing Number Date Filed Type Effective Date
220808000221 2021-12-21 ARTICLES OF ORGANIZATION 2021-12-21

Date of last update: 21 Mar 2025

Sources: New York Secretary of State