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  5. EAST SIDE SURGICAL GROUP, INC.

EAST SIDE SURGICAL GROUP, INC.

Company Details

Name: EAST SIDE SURGICAL GROUP, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 30 Mar 1973 (52 years ago)
Date of Dissolution: 27 Jul 2018 (7 years ago)
Date of Status Change: 27 Jul 2018 (7 years ago)
Identification Number: 000011297
ZIP code: 02860
County: Providence County
Principal Address: 10 EXCHANGE STREET APT. 601 RIVER FARMS LOFT, PAWTUCKET, RI, 02860, USA
Purpose: SURGICAL SERVICES
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Fictitious names: Breast Health (trading name, 1992-10-20 - )

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043496359 2008-01-16 2014-11-05 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 028605299, US 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 028605299, US

Contacts
Phone +1 401-312-0023
Fax 4013120006

Authorized person
Name DR. STEVEN I COHEN
Role PRESIDENT
Phone 4013120023

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number RI5011
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2013 050350767 2014-06-12 EAST SIDE SURGICAL GROUP 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2014-06-12
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2012 050350767 2013-05-23 EAST SIDE SURGICAL GROUP 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2013-05-23
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2011 050350767 2012-11-14 EAST SIDE SURGICAL GROUP 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2012-11-14
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2010 050350767 2011-10-31 EAST SIDE SURGICAL GROUP 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2011-10-31
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2009 050350767 2010-11-30 EAST SIDE SURGICAL GROUP 8
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2010-11-30
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature
EAST SIDE SURGICAL GROUP PROFIT SHARING TRUST 2009 050350767 2010-11-30 EAST SIDE SURGICAL GROUP 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-03-28
Business code 621111
Sponsor’s telephone number 4013120023
Plan sponsor’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050350767
Plan administrator’s name EAST SIDE SURGICAL GROUP
Plan administrator’s address 407 EAST AVENUE, SUITE 200, PAWTUCKET, RI, 02860
Administrator’s telephone number 4013120023

Signature of
Role Plan administrator
Date 2010-11-30
Name of individual signing STEVEN I. COHEN, MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ARNOLD H. HERMAN Agent 1 RANDALL SQUARE SUITE 402, PROVIDENCE, RI, 02904, USA

PRESIDENT

Name Role Address
STEVEN I COHEN PRESIDENT 10 EXCHANGE STREET, APT 601 PAWTUCKET, RI 02860 USA

Filings

Number Name File Date
201872945400 Articles of Dissolution 2018-07-27
201872943280 Annual Report 2018-07-27
201872944160 Annual Report 2018-07-27
201872939580 Reinstatement 2018-07-27
201752741270 Revocation Certificate For Failure to File the Annual Report for the Year 2017-11-02
201747688320 Revocation Notice For Failure to File An Annual Report 2017-07-27
201691109070 Annual Report 2016-01-22
201691107490 Annual Report - Amended 2016-01-22
201691106600 Statement of Change of Registered Office by the Registered Agent 2016-01-22
201690503040 Revocation Notice For Failure to File An Annual Report 2016-01-14

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 05 Oct 2024

Sources: Rhode Island Department of State

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