| CASE NUMBER | I-200-24124-956763 |
| CASE STATUS | Certified |
| RECEIVED DATE | 5/3/2024 |
| DECISION DATE | 5/10/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Nurse Practitioner |
| SOC CODE | 29-1171.00 |
| SOC TITLE | Nurse Practitioners |
| FULL TIME POSITION | Y |
| BEGIN DATE | 10/1/2024 |
| END DATE | 9/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Xie Yi Medical Office, P.C. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 139 Centre St. |
| EMPLOYER ADDRESS2 | Suite 715A |
| EMPLOYER CITY | New York |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 10013 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 19176393224 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Xie |
| EMPLOYER POC FIRST NAME | Yi |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | President |
| EMPLOYER POC ADDRESS1 | 139 Centre St. |
| EMPLOYER POC ADDRESS2 | Suite 715A |
| EMPLOYER POC CITY | New York |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 10013 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19176393224 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | yixie2006@gmail.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Lin |
| AGENT ATTORNEY FIRST NAME | Tao |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 60 East 42nd Street |
| AGENT ATTORNEY ADDRESS2 | 46th floor |
| AGENT ATTORNEY CITY | New York City |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 10165 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 16464805779 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | tlin@tlalaw.nyc |
| LAWFIRM NAME BUSINESS NAME | TLA LAW, ATTORNEYS AT LAW, PLLC |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | Court of Appeals, 2nd Appellate Division Department |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 139 Centre St. |
| WORKSITE ADDRESS2 | Suite 715A |
| WORKSITE CITY | New York |
| WORKSITE COUNTY | NEW YORK |
| WORKSITE STATE | NY |
| WORKSITE POSTAL CODE | 10013 |
| WAGE RATE OF PAY FROM | 140000 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $119,413.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2024-01-10 |
