| Entity Name: | MARVIN S. ROSENBLATT, PH.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Aug 1978 (47 years ago) |
| Document Number: | 581556 |
| FEI/EIN Number | 591842326 |
| Address: | 6203 WCOMMERCIAL BLVD, FORT LAUDERDALE, FL, 33319 |
| Mail Address: | 6203 WCOMMERCIAL BLVD, FORT LAUDERDALE, FL, 33319 |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467667097 | 2007-05-14 | 2020-08-22 | 6203 WEST COMMERCIAL BOULEVARD, FT.LAUDERDALE, FL, 33319, US | 6203 WEST COMMERCIAL BOULEVARD, FT.LAUDERDALE, FL, 33319, US | |||||||||||||||||||||||
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| Phone | +1 954-722-2020 |
Authorized person
| Name | DR. MARVIN S. ROSENBLATT |
| Role | PRESIDENT |
| Phone | 9547222020 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY 2555 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD ID |
| Number | 75781 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRAMLING FRANK R | Agent | 200 SE 13TH STREET, FORT LAUDERDALE, FL, 33316 |
| Name | Role | Address |
|---|---|---|
| EHLERS JANIS R | President | 6203 W. COMMERCIAL BLVD., FORT LAUDERDALE, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| EHLERS JANIS R | Director | 6203 W. COMMERCIAL BLVD., FORT LAUDERDALE, FL, 33319 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REINSTATEMENT | 2003-10-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
