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  5. East Bay Neurology, Professional Corporation

East Bay Neurology, Professional Corporation

Company Details

Name: East Bay Neurology, Professional Corporation
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 21 Apr 2003 (22 years ago)
Identification Number: 000131453
ZIP code: 02860
County: Providence County
Principal Address: 333 SCHOOL STREET SUITE 216, PAWTUCKET, RI, 02860, USA
Purpose: TO ENGAGE IN THE PRACTICE OF THE TREATMENT OF MEDICINE SPECIALIZING IN NEUROLOGICAL DISORDERS
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275668006 2007-02-22 2018-06-20 333 SCHOOL ST STE 216, PAWTUCKET, RI, 028605336, US 333 SCHOOL ST STE 216, PAWTUCKET, RI, 02860, US

Contacts
Phone +1 401-722-7300
Fax 4017227390

Authorized person
Name MOTASEM A AL YACOUB
Role PRESIDENT
Phone 4017244100

Taxonomy
Taxonomy Code 103G00000X - Clinical Neuropsychologist
License Number PS00999
State RI
Is Primary No
Taxonomy Code 2084N0400X - Neurology Physician
License Number MD 09501
State RI
Is Primary Yes
Taxonomy Code 2084N0400X - Neurology Physician
License Number 212368
State MA
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 7006029
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EAST BAY NEUROLOGY PROFESSIONAL CORP 401K PROFIT SHARING PLAN TR 2023 450512788 2024-07-01 EAST BAY NEUROLOGY PROFESSIONAL 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4017227300
Plan sponsor’s address 333 SCHOOL STREET, SUITE 216, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2024-07-01
Name of individual signing MOTASEM ALYACOUB
Valid signature Filed with authorized/valid electronic signature
EAST BAY NEUROLOGY PROFESSIONAL CORP 401K PROFIT SHARING PLAN TR 2022 450512788 2023-06-12 EAST BAY NEUROLOGY PROFESSIONAL 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4017227300
Plan sponsor’s address 333 SCHOOL STREET, SUITE 216, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2023-06-12
Name of individual signing MOTASEM ALYACOUB
Valid signature Filed with authorized/valid electronic signature
EAST BAY NEUROLOGY PROFESSIONAL CORP 401K PROFIT SHARING PLAN TR 2021 450512788 2022-06-08 EAST BAY NEUROLOGY PROFESSIONAL 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4017227300
Plan sponsor’s address 333 SCHOOL STREET, SUITE 216, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2022-06-08
Name of individual signing TATIANA ALYACOUB
Valid signature Filed with authorized/valid electronic signature
EAST BAY NEUROLOGY PROFESSIONAL CORP 401K PROFIT SHARING PLAN TR 2020 450512788 2021-09-27 EAST BAY NEUROLOGY PROFESSIONAL 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4017227300
Plan sponsor’s address 333 SCHOOL STREET, SUITE 216, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2021-09-27
Name of individual signing TATIANA ALYACOUB
Valid signature Filed with authorized/valid electronic signature
EAST BAY NEUROLOGY PROFESSIONAL CORP 401K PROFIT SHARING PLAN TR 2019 450512788 2020-06-30 EAST BAY NEUROLOGY PROFESSIONAL 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4017227300
Plan sponsor’s address 333 SCHOOL STREET, SUITE 216, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing TATIANA ALYACOUB
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STEPHEN D. ZUBIAGO, ESQ. Agent NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
MOTASEM ALYACOUB M.D PRESIDENT 333 SCHOOL ST. STE. 216 PAWTUCKET, RI 02860 USA

Filings

Number Name File Date
202448229450 Annual Report 2024-03-04
202329885670 Annual Report 2023-03-01
202212783850 Annual Report 2022-03-07
202194804370 Annual Report 2021-03-19
202035167590 Annual Report 2020-02-24
201988073220 Annual Report 2019-02-27
201859030970 Annual Report 2018-02-22
201735043980 Annual Report 2017-02-27
201692124090 Annual Report 2016-02-08
201555592790 Annual Report 2015-02-23

Related by officers

STEPHEN D. ZUBIAGO, ESQ.

Nicholas A. Califano, M.D., Inc. CARDIOLOGY ASSOCIATES, INC. MIRIAM IPA, INC. ORTHOPEDIC GROUP, INC. Bayside Endoscopy Group, Inc. Mobile Storage Inc. H & H TRUCKING INC. MIRIAM PHO, INC. Bayside OB-GYN, Inc. West Bay Orthopaedics and Neurosurgery, Inc.

Related by address

333 SCHOOL STREET SUITE 216, PAWTUCKET, RI, 02860, USA

THE JORDAN GROUP LLC

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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