| CASE NUMBER | I-200-24005-619666 |
| CASE STATUS | Certified |
| RECEIVED DATE | 1/5/2024 |
| DECISION DATE | 1/12/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | PHYSICIAN |
| SOC CODE | 29-1229.00 |
| SOC TITLE | Physicians, All Other |
| FULL TIME POSITION | Y |
| BEGIN DATE | 7/1/2024 |
| END DATE | 6/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | NORTHWELL HEALTH |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 2000 MARCUS AVENUE |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | NEW HYDE PARK |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 11042 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 15165175015 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 62211 |
| EMPLOYER POC LAST NAME | MELBOURNE |
| EMPLOYER POC FIRST NAME | KALA |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | ADVISOR, HR |
| EMPLOYER POC ADDRESS1 | 1991 MARCUS AVENUE |
| EMPLOYER POC ADDRESS2 | SUITE 310 |
| EMPLOYER POC CITY | LAKE SUCCESS |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 11042 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 15165175015 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | KMELBOURNE@NORTHWELL.EDU |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | FISHER |
| AGENT ATTORNEY FIRST NAME | THEDA |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 430 PARK AVENUE |
| AGENT ATTORNEY ADDRESS2 | 10TH FLOOR |
| AGENT ATTORNEY CITY | NEW YORK |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 10022 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12128489886 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | Theda.Fisher@withersworldwide.com |
| LAWFIRM NAME BUSINESS NAME | WITHERS BERGMAN LLP |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | COURT OF APPEALS |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 300 COMMUNITY DRIVE |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | MANHASSET |
| WORKSITE COUNTY | NASSAU |
| WORKSITE STATE | NY |
| WORKSITE POSTAL CODE | 11030 |
| WAGE RATE OF PAY FROM | 250000 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $174,304.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 2 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | FISHER |
| PREPARER FIRST NAME | THEDA |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | WITHERS BERGMAN LLP |
| PREPARER EMAIL | THEDA.FISHER@WITHERSWORLDWIDE.COM |
| BEGIN DATE CONVERTED | 2024-01-07 |
