| Entity Name: | NORTHWELL HEALTH MEDICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 28 Jul 2023 (2 years ago) |
| Document Number: | N23000009090 |
| FEI/EIN Number | 93-3512438 |
| Address: | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Mail Address: | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205604113 | 2023-12-20 | 2023-12-20 | 1411 N FLAGLER DR STE 7100, WEST PALM BEACH, FL, 334013418, US | 1411 N FLAGLER DR STE 7100, WEST PALM BEACH, FL, 334013418, US | |||||||||||||||
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| Phone | +1 561-475-5700 |
| Fax | 8775501796 |
Authorized person
| Name | DR. NICOLE BASILE |
| Role | ADMINISTRATOR |
| Phone | 5614755700 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Kalman, Jill | Director | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| D'Angelo, John, M.D | Director | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Battinelli, David, M.D | Director | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Name | Role | Address |
|---|---|---|
| Dowling, Michael J. | Chief Executive Officer | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Cusack, Michele L. | Chief Executive Officer | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Name | Role | Address |
|---|---|---|
| Schiff, Deborah | Executive Vice President | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Kraemer, Laurence A. | Executive Vice President | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Name | Role | Address |
|---|---|---|
| Basile, Nicole A. | Vice President | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Name | Role | Address |
|---|---|---|
| Kraemer, Laurence A. | General Counsel and Chief Legal Officer and Assistant Secretary | 2000 Marcus Avenue, New Hyde Park, NY 11042 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G25000010011 | NORTHWELL HEALTH PHYSICIAN PARTNERS AT WEST PALM BEACH | ACTIVE | 2025-01-24 | 2030-12-31 | No data | 2000 MARCUS AVENUE, NEW HYDE PARK, NY, 11762 |
| G25000010012 | NHPP AT WEST PALM BEACH | ACTIVE | 2025-01-24 | 2030-12-31 | No data | 2000 MARCUS AVENUE, NEW HYDE PARK, NY, 11762 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-01 | 2000 Marcus Avenue, New Hyde Park, NY 11042 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-01 | 2000 Marcus Avenue, New Hyde Park, NY 11042 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| Domestic Non-Profit | 2023-07-28 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
