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  5. PEDIATRIC NEUROLOGY, INC.

PEDIATRIC NEUROLOGY, INC.

Company Details

Name: PEDIATRIC NEUROLOGY, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 29 Dec 1993 (31 years ago)
Identification Number: 000075165
ZIP code: 02864
County: Providence County
Principal Address: 2138 MENDON ROAD SUITE 104, CUMBERLAND, RI, 02864, USA
Purpose: GENERAL PRACTICE OF MEDICINE, PRIVATE PRACTICE OF PEDIATRICS AND PEDIATRIC & ADULT NEUROLOGY.
Fictitious names: PEDIATRIC NEUROLOGY (trading name, 1994-01-12 - )

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

Companies doing Offices of physicians (except mental health specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720121635 2007-02-14 2020-08-22 2138 MENDON RD, UNIT 104, CUMBERLAND, RI, 028643834, US 2138 MENDON RD, UNIT 104, CUMBERLAND, RI, 028643834, US

Contacts
Phone +1 401-334-0424

Authorized person
Name MARIA C. YOUNES
Role PRESIDENT
Phone 4013340424

Taxonomy
Taxonomy Code 2084N0402X - Neurology with Special Qualifications in Child Neurology Physician
License Number 7691
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number PN44005
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2023 050475100 2024-10-01 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2022 050475100 2023-08-29 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2021 050475100 2022-07-05 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2020 050475100 2021-10-06 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2019 050475100 2020-10-13 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2018 050475100 2019-05-02 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2017 050475100 2018-06-05 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2016 050475100 2017-09-12 PEDIATRIC NEUROLOGY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2015 050475100 2016-09-29 PEDIATRIC NEUROLOGY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
PEDIATRIC NEUROLOGY, INC. PROFIT SHARING PLAN AND TRUST 2014 050475100 2015-10-14 PEDIATRIC NEUROLOGY, INC. 4
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/14/20151014112544P030048145745001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/09/20141009075211P040014604687001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050475100
Plan administrator’s name PEDIATRIC NEUROLOGY, INC.
Plan administrator’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
Administrator’s telephone number 4013340424

Signature of
Role Plan administrator
Date 2014-10-09
Name of individual signing MARIA C. YOUNES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/10/20131010155952P030029653427001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050475100
Plan administrator’s name PEDIATRIC NEUROLOGY, INC.
Plan administrator’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
Administrator’s telephone number 4013340424

Signature of
Role Plan administrator
Date 2013-10-10
Name of individual signing MARIA C. YOUNES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/11/20121011144611P040001263174001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050475100
Plan administrator’s name PEDIATRIC NEUROLOGY, INC.
Plan administrator’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
Administrator’s telephone number 4013340424

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing MARIA C. YOUNES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/07/20111007134049P030670566576001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050475100
Plan administrator’s name PEDIATRIC NEUROLOGY, INC.
Plan administrator’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
Administrator’s telephone number 4013340424

Signature of
Role Plan administrator
Date 2011-10-07
Name of individual signing MARIA C. YOUNES
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/04/20101004140901P040001110355001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 4013340424
Plan sponsor’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050475100
Plan administrator’s name PEDIATRIC NEUROLOGY, INC.
Plan administrator’s address 2138 MENDON ROAD, SUITE 104, CUMBERLAND, RI, 02864
Administrator’s telephone number 4013340424

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing MARIA C. YOUNES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHN S. PETRONE, ESQ. Agent 1395 ATWOOD AVENUE SUITE 203B, JOHNSTON, RI, 02919, USA

PRESIDENT

Name Role Address
MARIA C YOUNES MD PRESIDENT 2138 MENDON ROAD, UNIT 104 CUMBERLAND, RI 02864- USA

Filings

Number Name File Date
202446466190 Annual Report 2024-02-05
202332193490 Annual Report 2023-03-31
202209594920 Annual Report 2022-02-03
202104500440 Annual Report 2021-11-02
202104500800 Statement of Change of Registered/Resident Agent 2021-11-02
202104500170 Reinstatement 2021-11-02
202187940690 Revocation Certificate For Failure to Maintain a Registered Agent 2021-01-27
202076638600 Revocation Notice For Failure to Maintain a Registered Agent 2020-11-20
202051149260 Agent Resigned 2020-08-31
202036659850 Annual Report 2020-03-22

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6205457306 2020-04-30 0165 PPP 2138 MENDON RD SUITE 104, CUMBERLAND, RI, 02864
Loan Status Date 2021-04-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 57717
Loan Approval Amount (current) 57717
Undisbursed Amount 0
Franchise Name -
Lender Location ID 65657
Servicing Lender Name BankNewport
Servicing Lender Address 10 Washington Sq, NEWPORT, RI, 02840-2948
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address CUMBERLAND, PROVIDENCE, RI, 02864-0001
Project Congressional District RI-01
Number of Employees 5
NAICS code 621111
Borrower Race White
Borrower Ethnicity Hispanic or Latino
Business Type Corporation
Originating Lender ID 65657
Originating Lender Name BankNewport
Originating Lender Address NEWPORT, RI
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 58248.31
Forgiveness Paid Date 2021-04-06

Related by officers

JOHN S. PETRONE, ESQ.

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Related by address

No related companies by address

Date of last update: 08 Apr 2025

Sources: Rhode Island Department of State

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