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  5. PETER A. KLEIN, M.D., F.A.A.D., P.C.

PETER A. KLEIN, M.D., F.A.A.D., P.C.

Company Details

Name: PETER A. KLEIN, M.D., F.A.A.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 21 Jan 2003 (22 years ago)
Entity Number: 2859297
ZIP code: 11776
County: Nassau
Place of Formation: New York
Address: 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON STATION, NY, United States, 11776
Principal Address: 6 MEDICAL DRIVE, SUITE D, PT JEFFERSON STATION, NY, United States, 11776

Contact Details

Phone +1 631-475-8249

Phone +1 631-223-4599

Phone +1 631-928-7922

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2023 331039948 2024-10-05 PETER A. KLEIN, M.D., F.A.A.D., P.C. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2024-10-06
Name of individual signing PETER A KLEIN MD
Valid signature Filed with authorized/valid electronic signature
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2022 331039948 2023-09-26 PETER A. KLEIN, M.D., F.A.A.D., P.C. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2023-09-27
Name of individual signing PETER A KLEIN MD
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2021 331039948 2022-10-02 PETER A. KLEIN, M.D., F.A.A.D., P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2022-10-02
Name of individual signing PETER A KLEIN
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2020 331039948 2021-10-10 PETER A. KLEIN, M.D., F.A.A.D., P.C. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2021-10-10
Name of individual signing PETER KLEIN
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2019 331039948 2020-10-03 PETER A. KLEIN, M.D., F.A.A.D., P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2020-10-03
Name of individual signing PETER A KLEIN
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2018 331039948 2019-09-26 PETER A. KLEIN, M.D., F.A.A.D., P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2019-09-26
Name of individual signing PETER A KLEIN
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2017 331039948 2018-10-08 PETER A. KLEIN, M.D., F.A.A.D., P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2018-10-08
Name of individual signing PETER KLEIN
PETER A. KLEIN, M.D., F.A.A.D., P.C. 401(K) PROFIT SHARING PLAN 2016 331039948 2017-10-09 PETER A. KLEIN, M.D., F.A.A.D.,P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON, NY, 11776

Signature of
Role Plan administrator
Date 2017-10-09
Name of individual signing DR PETER A KLEIN
PETER A. KLEIN, M.D., F.A.A.D.,P.C 401(K) PROFIT SHARING PLAN 2015 331039948 2016-09-08 PETER A. KLEIN, M.D., F.A.A.D.,P.C 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON STATION, NY, 11776

Signature of
Role Plan administrator
Date 2016-09-08
Name of individual signing PETER A. KLEIN
PETER A. KLEIN, M.D., F.A.A.D.,P.C 401(K) PROFIT SHARING PLAN 2014 331039948 2015-06-30 PETER A. KLEIN, M.D., F.A.A.D.,P.C 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6319287922
Plan sponsor’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON STATION, NY, 11776

Plan administrator’s name and address
Administrator’s EIN 331039948
Plan administrator’s name PETER A. KLEIN, M.D., F.A.A.D.,P.C
Plan administrator’s address 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON STATION, NY, 11776
Administrator’s telephone number 6319287922

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing PETER A. KLEIN

DOS Process Agent

Name Role Address
PETER A. KLEIN, M.D., F.A.A.D., P.C. DOS Process Agent 6 MEDICAL DRIVE, SUITE D, PORT JEFFERSON STATION, NY, United States, 11776

Chief Executive Officer

Name Role Address
PETER A KLEIN Chief Executive Officer 6 MEDICAL DRIVE, SUITE D, PT JEFFERSON STATION, NY, United States, 11776

History

Start date End date Type Value
2007-01-17 2013-02-11 Address 6 MEDICAL DRIVE, SUITE D, PT JEFFERSON STATION, NY, 11776, USA (Type of address: Chief Executive Officer)
2005-02-14 2007-01-17 Address 20 ROBERT CRESCENT, STONY BROOK, NY, 11790, USA (Type of address: Chief Executive Officer)
2005-02-14 2021-01-04 Address 6 MEDICAL DRIVE, SUITE D, PT JEFFERSON STATION, NY, 11776, USA (Type of address: Service of Process)
2003-01-21 2005-02-14 Address 78 POPLAR STREET, GARDEN CITY, NY, 11530, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210104060332 2021-01-04 BIENNIAL STATEMENT 2021-01-01
190108060616 2019-01-08 BIENNIAL STATEMENT 2019-01-01
170109006664 2017-01-09 BIENNIAL STATEMENT 2017-01-01
150120006078 2015-01-20 BIENNIAL STATEMENT 2015-01-01
130211002295 2013-02-11 BIENNIAL STATEMENT 2013-01-01
110121002180 2011-01-21 BIENNIAL STATEMENT 2011-01-01
090108002857 2009-01-08 BIENNIAL STATEMENT 2009-01-01
070117002065 2007-01-17 BIENNIAL STATEMENT 2007-01-01
050214002046 2005-02-14 BIENNIAL STATEMENT 2005-01-01
030121000694 2003-01-21 CERTIFICATE OF INCORPORATION 2003-01-21

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 28 Nov 2024

Sources: New York Secretary of State

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