| Entity Name: | VIP MEDICAL CENTER, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Aug 2014 (11 years ago) |
| Document Number: | L14000131135 |
| FEI/EIN Number | 47-1709897 |
| Address: | 2500 E HALLANDALE BEACH BLVD., SUITE 207, HALLANDALE, FL 33009 |
| Mail Address: | 12628 NW 74 Pl, Parkland, FL 33076 |
| ZIP code: | 33009 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639570674 | 2014-09-09 | 2014-10-06 | 301 174TH STREET, SUITE 1714, SUNNY ISLES, FL, 33160, US | 2500 E HALLANDALE BEACH BLVD, SUITE 203, HALLANDALE BEACH, FL, 330094834, US | |||||||||||||||||||||||||
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| Phone | +1 954-501-0010 |
| Fax | 3054559676 |
Authorized person
| Name | GENRIYETTA ROZENBLAT |
| Role | OWNER PHYSICIAN |
| Phone | 3053185696 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS11798 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006672600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROZENBLAT, GENRIETTA | Agent | 12628 NW 74 Pl, Parkland, FL 33076 |
| Name | Role | Address |
|---|---|---|
| ROZENBLAT, GENRIETTA | President | 12628 NW 74 Pl, Parkland, FL 33076 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000077522 | VIP AESTHETIC CENTER | ACTIVE | 2017-07-19 | 2027-12-31 | No data | 21382 MARINA COVE CIR, UNIT D16, AVENTURA, FL, 33180--355 |
| G15000081141 | PROGRESSIVE MEDICAL CENTER | EXPIRED | 2015-08-05 | 2020-12-31 | No data | 2500 E HALLANDALE BEACH BLVD, SUITE 203, HALLANDALE, FL, 33009 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-01-22 | 2500 E HALLANDALE BEACH BLVD., SUITE 207, HALLANDALE, FL 33009 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-22 | 12628 NW 74 Pl, Parkland, FL 33076 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-11 | 2500 E HALLANDALE BEACH BLVD., SUITE 207, HALLANDALE, FL 33009 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-11 | 21382 Marina Cove Cir, Unit D16, Aventura, FL 33180 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-06-08 | 2500 E HALLANDALE BEACH BLVD., SUITE 207, HALLANDALE, FL 33009 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-22 |
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-01-11 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-01-03 |
| ANNUAL REPORT | 2020-01-06 |
| ANNUAL REPORT | 2019-01-15 |
| ANNUAL REPORT | 2018-01-09 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-28 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1124737705 | 2020-05-01 | 0455 | PPP | 21382 Marina Cove Cir Unit D16, AVENTURA, FL, 33180 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 20 Feb 2025
Sources: Florida Department of State
