| Entity Name: | ELVIN SAM, CRNA, P.C. |
| Jurisdiction: | Connecticut |
| Legal type: | Stock |
| Citizenship: | Domestic |
| Status: | Forfeited |
| Sub status: | Ready for Forfeiture |
| Date Formed: | 01 Jul 2021 |
| Business ALEI: | 2291921 |
| Annual report due: | 30 Sep 2022 |
| NAICS code: | 622110 - General Medical and Surgical Hospitals |
| Business address: | 775 Mix Ave, Hamden, CT, 06514-2121, United States |
| Mailing address: | 775 Mix Ave, C, Hamden, CT, United States, 06514-2121 |
| ZIP code: | 06514 |
| County: | New Haven |
| Place of Formation: | CONNECTICUT |
| Total authorized shares: | 200 |
| E-Mail: | elvinms627@gmail.com |
| Name | Role | Business address | Mailing address | Residence address | |
|---|---|---|---|---|---|
| Elvin Sam | Agent | 775 Mix Avenue, Apt C, Hamden, CT, 06514, United States | 775 Mix Avenue, Apt C, Hamden, CT, 06514, United States | elvinms627@gmail.com | 775 Mix Avenue, Apt C, Hamden, CT, 06514, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| Diane Peyser | Officer | 1615 Northern Blvd, 303, Manhasset, NY, 11030-3008, United States | 1615 Northern Blvd, 303, Manhasset, NY, 11030-3008, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012775944 | 2024-09-27 | No data | Administrative Dissolution | Certificate of Dissolution/Revocation | No data |
| BF-0012669968 | 2024-06-20 | No data | Administrative Dissolution | Notice of Intent to Dissolve/Revoke | No data |
| BF-0010077916 | 2021-09-30 | 2021-09-30 | First Report | Organization and First Report | No data |
| BF-0010075665 | 2021-07-01 | No data | Business Formation | Certificate of Incorporation | No data |
Date of last update: 27 Jan 2025
Sources: Connecticut's Official State Website
