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HAVEN FAMILY MEDICINE, P.C.

Company Details

Name: HAVEN FAMILY MEDICINE, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 06 Apr 2023 (2 years ago)
Entity Number: 6792803
ZIP code: 11554
County: New York
Place of Formation: New York
Address: 840 wenwood drive, EAST MEADOW, NY, United States, 11554

Contact Details

Phone +1 212-927-3232

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
the PROFESSIONAL CORPORATION DOS Process Agent 840 wenwood drive, EAST MEADOW, NY, United States, 11554

National Provider Identifier

NPI Number:
1003503392
Certification Date:
2025-04-09

Authorized Person:

Name:
ROBERTO MORAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2129274571

Filings

Filing Number Date Filed Type Effective Date
230406004025 2023-04-06 CERTIFICATE OF INCORPORATION 2023-04-06

Date of last update: 20 Mar 2025

Sources: New York Secretary of State