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  5. Edward A. Pensa Medical, Inc.

Edward A. Pensa Medical, Inc.

Company Details

Name: Edward A. Pensa Medical, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 24 Mar 2008 (17 years ago)
Date of Dissolution: 28 Feb 2012 (13 years ago)
Date of Status Change: 28 Feb 2012 (13 years ago)
Identification Number: 000319001
ZIP code: 02905
County: Providence County
Principal Address: 33 STANIFORD STREET, PROVIDENCE, RI, 02905, USA
Purpose: MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1437324530 2008-04-29 2008-07-15 33 STANIFORD ST, PROVIDENCE, RI, 029053105, US 33 STANIFORD ST, PROVIDENCE, RI, 029053105, US

Contacts
Phone +1 401-421-8800
Fax 4012736510

Authorized person
Name DR. EDWARD A. PENSA
Role OWNER/PHYSICIAN
Phone 4014218800

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
License Number 11377
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EDWARD A. PENSA MEDICAL, INC. RETIREMENT PLAN 2012 262242443 2013-06-20 EDWARD A. PENSA MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 262242443
Plan administrator’s name EDWARD A. PENSA MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing JAMES W. STAUFFER
Valid signature Filed with authorized/valid electronic signature
EDWARD A. PENSA MEDICAL, INC. RETIREMENT PLAN 2011 262242443 2012-07-09 EDWARD A. PENSA MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 262242443
Plan administrator’s name EDWARD A. PENSA MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of
Role Plan administrator
Date 2012-07-09
Name of individual signing EDWARD A. PENSA
Valid signature Filed with authorized/valid electronic signature
EDWARD A. PENSA MEDICAL, INC. RETIREMENT PLAN 2010 262242443 2011-06-29 EDWARD A. PENSA MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 262242443
Plan administrator’s name EDWARD A. PENSA MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing EDWARD A. PENSA
Valid signature Filed with authorized/valid electronic signature
EDWARD A. PENSA MEDICAL, INC. RETIREMENT PLAN 2009 262242443 2010-10-08 EDWARD A. PENSA MEDICAL, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4014218800
Plan sponsor’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 262242443
Plan administrator’s name EDWARD A. PENSA MEDICAL, INC.
Plan administrator’s address 33 STANIFORD STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4014218800

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing CAROL LIPMAN
Valid signature Filed with authorized/valid electronic signature

Agent

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

PRESIDENT

Name Role Address
EDWARD A PENSA M.D. PRESIDENT 33 STANIFORD STREET PROVIDENCE, RI 02905

Filings

Number Name File Date
201290324810 Articles of Dissolution 2012-02-28
201174253410 Annual Report 2011-01-31
201058472760 Annual Report 2010-02-16
200943314440 Annual Report 2009-02-26
200808470540 Articles of Incorporation 2008-03-24

Related by officers

STEPHEN D. ZUBIAGO

ROGER WILLIAMS UNIVERSITY Renaissance Medical, Ltd. South County Health Care Associates, Inc. Howard S. Lilienfeld, M.D., P.C. Roger Williams Medical Associates, Inc. Southern New England Occupational Health, L.L.C. Transcription Associates of Southeastern New England, Inc. American Home Care Services, Inc. Access Bahavioral Care, Inc. Hoop Specialists, LLC

Related by address

33 STANIFORD STREET, PROVIDENCE, RI, 02905, USA

Nicholas A. Califano, M.D., Inc. SHELDON LIDOFSKY, M.D. INC. Bayside Endoscopy Group, Inc. Thomas D. DeNucci, M.D., Inc. Paul E.A. VanZuiden, M,D., F.A.C.P., Inc. University Gastroenterology Practice, Inc. Paul A. Akerman, M.D., Inc. Thomas E. Sepe, M.D., Inc. Peter S. Margolis, M.D., Inc. STANIFORD REALTY, LLC

Date of last update: 12 Oct 2024

Sources: Rhode Island Department of State

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