| Name: | NORTH SHORE MEDICAL REHABILITATION, P.C. |
| Jurisdiction: | New York |
| Legal type: | DOMESTIC PROFESSIONAL SERVICE CORPORATION |
| Status: | Active |
| Date of registration: | 12 Sep 2000 (24 years ago) |
| Entity Number: | 2551596 |
| ZIP code: | 11560 |
| County: | Nassau |
| Place of Formation: | New York |
| Address: | 8 THE KNLS, LOCUST VALLEY, NY, United States, 11560 |
| Principal Address: | 25 WILLET AVENUE, HICKSVILLE, NY, United States, 11801 |
Shares Details
Shares issued 200
Share Par Value 0
Type NO PAR VALUE
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH SHORE REHABILITATION P.C. RETIREMENT TRUST | 2020 | 113572061 | 2021-06-16 | NORTH SHORE MEDICAL REHABILITATION, P.C. | 7 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2021-06-16 |
| Name of individual signing | PLAN SPONSOR |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 5162009088 |
| Plan sponsor’s address | 8 THE KNLS, LOCUST VALLEY, NY, 11560 |
Signature of
| Role | Plan administrator |
| Date | 2021-06-16 |
| Name of individual signing | KWAN-IONG JAKOBSEN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 5162009088 |
| Plan sponsor’s address | 8 THE KNLS, LOCUST VALLEY, NY, 11560 |
Signature of
| Role | Plan administrator |
| Date | 2020-06-30 |
| Name of individual signing | KWAN JAKOBSEN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 5162009088 |
| Plan sponsor’s address | 8 THE KNLS, LOCUST VALLEY, NY, 11560 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-09 |
| Name of individual signing | KWAN JAKOBSEN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 5162009088 |
| Plan sponsor’s address | 8 THE KNLS, LOCUST VALLEY, NY, 11560 |
Signature of
| Role | Plan administrator |
| Date | 2018-07-07 |
| Name of individual signing | KWAN JAKOBSEN |
| Name | Role | Address |
|---|---|---|
| NORTH SHORE MEDICAL REHABILITATION, P.C. | DOS Process Agent | 8 THE KNLS, LOCUST VALLEY, NY, United States, 11560 |
| Name | Role | Address |
|---|---|---|
| GLENN JAKOBSEN DO | Chief Executive Officer | 83-71 116TH ST., STE M2, RICHMOND HILL, NY, United States, 11418 |
| Start date | End date | Type | Value |
|---|---|---|---|
| 2016-09-14 | 2018-09-11 | Address | 969 RIPLEY LN, STE B, OYSTER BAY, NY, 11771, USA (Type of address: Service of Process) |
| 2010-02-17 | 2020-10-13 | Address | 40-05 68TH STREET, STE B, WOODSIDE, NY, 11377, USA (Type of address: Chief Executive Officer) |
| 2010-02-17 | 2016-09-14 | Address | 40-05 68TH STREET, STE B, WOODSIDE, NY, 11377, USA (Type of address: Service of Process) |
| 2000-09-12 | 2010-02-17 | Address | 265 POST AVENUE, SUITE 100, WESTBURY, NY, 11590, USA (Type of address: Service of Process) |
| Filing Number | Date Filed | Type | Effective Date |
|---|---|---|---|
| 201013060515 | 2020-10-13 | BIENNIAL STATEMENT | 2020-09-01 |
| 180911006219 | 2018-09-11 | BIENNIAL STATEMENT | 2018-09-01 |
| 160914006037 | 2016-09-14 | BIENNIAL STATEMENT | 2016-09-01 |
| 140929006395 | 2014-09-29 | BIENNIAL STATEMENT | 2014-09-01 |
| 120914006078 | 2012-09-14 | BIENNIAL STATEMENT | 2012-09-01 |
| 100914002507 | 2010-09-14 | BIENNIAL STATEMENT | 2010-09-01 |
| 100217002629 | 2010-02-17 | BIENNIAL STATEMENT | 2008-09-01 |
| 000912000368 | 2000-09-12 | CERTIFICATE OF INCORPORATION | 2000-09-12 |
Date of last update: 11 Nov 2024
Sources: New York Secretary of State
