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LONG ISLAND FAMILY MEDICAL GROUP, P.C.

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Company Details

Name: LONG ISLAND FAMILY MEDICAL GROUP, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Inactive
Date of registration: 04 Mar 1985 (40 years ago)
Date of dissolution: 26 Aug 2016
Entity Number: 978024
ZIP code: 11751
County: Suffolk
Place of Formation: New York
Address: 120 ELDER ROAD, ISLIP, NY, United States, 11751

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name Role Address
ERNEST FREILER DOS Process Agent 120 ELDER ROAD, ISLIP, NY, United States, 11751

Chief Executive Officer

Name Role Address
ERNEST FREILER Chief Executive Officer 120 ELDER ROAD, ISLIP, NY, United States, 11751

National Provider Identifier

NPI Number:
1447312988

Authorized Person:

Name:
MRS. MARGARET M SIMAT
Role:
PRACTICE ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
6315894793

Form 5500 Series

Employer Identification Number (EIN):
112731890
Plan Year:
2014
Number Of Participants:
1
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
38
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
28
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
32
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
32
Sponsors Telephone Number:

History

Start date End date Type Value
1993-04-30 1999-03-18 Address 182 SHADY BROOK LANE, WEST ISLIP, NY, 11795, USA (Type of address: Chief Executive Officer)
1993-04-30 1999-03-18 Address 182 SHADY BROOK LANE, WEST ISLIP, NY, 11795, USA (Type of address: Principal Executive Office)
1993-04-30 1999-03-18 Address 182 SHADY BROOK LANE, WEST ISLIP, NY, 11795, USA (Type of address: Service of Process)
1985-03-04 1993-04-30 Address 182 SHADYBROOK LANE, WEST ISLIP, NY, 11795, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
160826000298 2016-08-26 CERTIFICATE OF DISSOLUTION 2016-08-26
110325002398 2011-03-25 BIENNIAL STATEMENT 2011-03-01
090225002009 2009-02-25 BIENNIAL STATEMENT 2009-03-01
070316002237 2007-03-16 BIENNIAL STATEMENT 2007-03-01
050405002648 2005-04-05 BIENNIAL STATEMENT 2005-03-01

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Date of last update: 17 Mar 2025

Sources: New York Secretary of State