| CASE NUMBER | I-200-24064-767841 |
| CASE STATUS | Certified |
| RECEIVED DATE | 3/4/2024 |
| DECISION DATE | 3/11/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physician in a Post Graduate Training Program |
| SOC CODE | 29-1229.00 |
| SOC TITLE | Physicians, All Other |
| FULL TIME POSITION | Y |
| BEGIN DATE | 7/1/2024 |
| END DATE | 6/30/2025 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | NYCHHC - Jacobi Medical Center |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 1400 Pelham Parkway South |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Bronx |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 10461 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17189185000 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Urena |
| EMPLOYER POC FIRST NAME | Masiel |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Associate Director, Graduate Medical Education |
| EMPLOYER POC ADDRESS1 | 1400 Pelham Parkway South |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Bronx |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 10461 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17189185006 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | Masiel.Urena@nychhc.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Dunham |
| AGENT ATTORNEY FIRST NAME | Carol |
| AGENT ATTORNEY MIDDLE NAME | Gibbons |
| AGENT ATTORNEY ADDRESS1 | 10-27 46th Avenue |
| AGENT ATTORNEY ADDRESS2 | Suite 300-2 |
| AGENT ATTORNEY CITY | Long Island City |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 11101 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12123568195 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | cdunham@cirseiu.org |
| LAWFIRM NAME BUSINESS NAME | House Staff Benefits Plan |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | Appellate Division, First Department |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 1400 Pelham Parkway South |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Bronx |
| WORKSITE COUNTY | BRONX |
| WORKSITE STATE | NY |
| WORKSITE POSTAL CODE | 10461 |
| WAGE RATE OF PAY FROM | 81771 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $81,771.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | |
| PW OES YEAR | |
| PW OTHER SOURCE | CBA |
| PW OTHER YEAR | 2018 |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| 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 | Ramirez |
| PREPARER FIRST NAME | Sarah |
| PREPARER MIDDLE INITIAL | M |
| PREPARER BUSINESS NAME | House Staff Benefits Plan |
| PREPARER EMAIL | sramirez@cirseiu.org |
| BEGIN DATE CONVERTED | 2024-01-07 |
