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  5. PALM BEACH INTERNAL MEDICINE, LLC

PALM BEACH INTERNAL MEDICINE, LLC

Company Details

Entity Name: PALM BEACH INTERNAL MEDICINE, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 19 Jul 2004 (21 years ago)
Document Number: L04000054440
FEI/EIN Number 331096450
Address: 3502 Kyoto Gardens Drive, Suite A, PALM BEACH GARDENS, FL, 33410, US
Mail Address: 11700 landing place, North Palm Beach, FL, 33408, US
ZIP code: 33410
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1063695708 2007-12-17 2020-08-10 3502 KYOTO GARDENS DR STE A, PALM BEACH GARDENS, FL, 334102899, US 3502 KYOTO GARDENS DR, PALM BEACH GARDENS, FL, 334102984, US

Contacts
Phone +1 561-776-8891
Fax 8664362183

Authorized person
Name DR. RUPESH R DHARIA
Role MANAGING MEMBER
Phone 5612679311

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME082262
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2019 331096450 2020-10-12 PALM BEACH INTERNAL MEDICINE, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3502 KYOTO GARDENS DRIVE, SUITE A, PALM BEACH GARDENS, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2018 331096450 2019-09-19 PALM BEACH INTERNAL MEDICINE, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3502 KYOTO GARDENS DRIVE, SUITE A, PALM BEACH GARDENS, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2017 331096450 2018-07-06 PALM BEACH INTERNAL MEDICINE, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3502 KYOTO GARDEN DR SUITE A, PALM BEACH GARDEN, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2016 331096450 2017-07-11 PALM BEACH INTERNAL MEDICINE, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3401 PGA BLVD STE 310, PALM BEACH GARDENS, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2015 331096450 2016-09-16 PALM BEACH INTERNAL MEDICINE, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3401 PGA BLVD STE 310, PALM BEACH GARDENS, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2014 331096450 2015-07-29 PALM BEACH INTERNAL MEDICINE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3401 PGA BLVD STE 310, PALM BEACH GARDENS, FL, 33410
PALM BEACH INTERNAL MEDICINE 401(K) PLAN 2013 331096450 2014-06-20 PALM BEACH INTERNAL MEDICINE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 5617768891
Plan sponsor’s address 3401 PGA BLVD STE 310, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing DR. RUPESH DHARIA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HALICKMAN DOREEN BONADIE Agent 102 OLIVERA WAY, PALM BEACH GARDENS, FL, 33418

Auth

Name Role Address
DHARIA RUPESH R Auth 11700 LANDING PLACE, NORTH PALM BEACH, FL, 33408

Chief Financial Officer

Name Role Address
Dharia Sami R Chief Financial Officer 3502 Kyoto Gardens Drive, PALM BEACH GARDENS, FL, 33410

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-02-06 3502 Kyoto Gardens Drive, Suite A, PALM BEACH GARDENS, FL 33410 No data
CHANGE OF PRINCIPAL ADDRESS 2017-08-28 3502 Kyoto Gardens Drive, Suite A, PALM BEACH GARDENS, FL 33410 No data

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-03-30
AMENDED ANNUAL REPORT 2022-06-21
ANNUAL REPORT 2022-03-17
ANNUAL REPORT 2021-02-06
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-03-28
ANNUAL REPORT 2018-03-01
AMENDED ANNUAL REPORT 2017-08-28
ANNUAL REPORT 2017-01-25

Related by officers

DHARIA RUPESH R

PGA SKIN AND VITAMIN CARE, INC. RAYDAR CONSULTING, LLC PALM BEACH MEDICAL ASSOCIATES, LLC

Dharia Sami R

RAYDAR CONSULTING, LLC

HALICKMAN DOREEN BONADIE

PALM BEACH MEDICAL ASSOCIATES, LLC

Related by address

11700 landing place, North Palm Beach, FL, 33408, US

RAYDAR CONSULTING, LLC DHARIA RESEARCH AND DEVELOPMENT, INC.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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