black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

PET ASSURE CORP

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN314774
Status:
First Licensure:
08/15/2018
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
211 BOULEVARD OF AMERICAS STE 403
LAKEWOOD, NJ 08701-4778
Mailing:
211 BOULEVARD OF AMERICAS STE 403
LAKEWOOD, NJ 08701-4778
Phone:
+1 (732) 987-3781
Fax:
+1 (732) 987-3781
Email:
stacey@wishboneinsurance.com

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 08/15/2018 04/01/2027

Alias, DBA or Trade Name

Name
PET BENEFIT SOLUTIONS

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN PET INSURANCE COMPANY
10/27/2021 PCF204502
EVERSPAN INSURANCE COMPANY
09/17/2024 PCF34218
INDEPENDENCE AMERICAN INSURANCE COMPANY
08/15/2023 PCF86149
PROVIDENCE WASHINGTON INSURANCE COMPANY
03/26/2025 PCF563

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
AMY IRENE CRANE
06/22/2021 PRN186416
CHAYA MIRIAM NOCHOMOVITZ
08/15/2018 PRN310957
DIANE BETH PAGE
08/28/2018 PRN232126

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
CHAYA MIRIAM NOCHOMOVITZ PRN310957

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
18875614

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 05/14/2025 10:54:04 AM