| Entity Name: | ALLERGY ASSOCIATES OF THE PALM BEACHES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 20 Jun 1980 (45 years ago) |
| Date of dissolution: | 27 Dec 2024 (2 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Dec 2024 (2 months ago) |
| Document Number: | 675393 |
| FEI/EIN Number | 59-2004475 |
| Address: | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Mail Address: | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| ZIP code: | 33408 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1720082753 | 2005-06-08 | 2013-02-12 | 840 US HIGHWAY 1, SUITE 235, NORTH PALM BEACH, FL, 334083830, US | 840 US HWY #1, SUITE 235, NORTH PALM BEACH, FL, 33408, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-626-2006 |
| Fax | 5616249718 |
Authorized person
| Name | MARK RODGER STEIN |
| Role | PRESIDENT |
| Phone | 5616262006 |
Taxonomy
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | ME34195 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | 058623 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | ARNP2029482 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207K00000X - Allergy & Immunology Physician |
| License Number | ARNP2993372 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | Y7113 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | K0216 |
| State | FL |
| Issuer | MEDICARE |
| Number | E7878Z |
| State | FL |
| Issuer | UPIN |
| Number | H67966 |
| State | FL |
| Issuer | UPIN |
| Number | S51831 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Nicely, Derk A | Agent | 840 US HWY 1, STE. 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| KOTERBA, ALAN P | President | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| KOTERBA, ALAN P | Treasurer | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| KOTERBA, ALAN P | Asst. Secretary | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| PEREZ, ELENA | Vice President | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| PEREZ, ELENA | Asst. Treasurer | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Name | Role | Address |
|---|---|---|
| PEREZ, ELENA | Secretary | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-12-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-06-06 | Nicely, Derk A | No data |
| AMENDMENT | 2018-10-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-14 | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-14 | 840 US HWY 1, STE 235, NORTH PALM BEACH, FL 33408 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-03-14 | 840 US HWY 1, STE. 235, NORTH PALM BEACH, FL 33408 | No data |
| NAME CHANGE AMENDMENT | 1989-09-28 | ALLERGY ASSOCIATES OF THE PALM BEACHES, P.A. | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-12-27 |
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-03-15 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-06-06 |
| Amendment | 2018-10-04 |
| ANNUAL REPORT | 2018-03-24 |
| ANNUAL REPORT | 2017-01-24 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
