| Entity Name: | MOSKOWITZ DERMATOLOGY, M.D., P.L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 29 Jan 2016 (9 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 24 Feb 2017 (8 years ago) |
| Document Number: | L16000018395 |
| FEI/EIN Number | 81-1011375 |
| Address: | 143 Mission Road, OVIEDO, FL 32765 |
| Mail Address: | 143 Mission Road, OVIEDO, FL 32765 |
| ZIP code: | 32765 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609234608 | 2016-02-04 | 2016-02-04 | 1000 W BROADWAY ST, SUITE 206, OVIEDO, FL, 327659260, US | 1000 W BROADWAY ST, SUITE 206, OVIEDO, FL, 327659260, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 407-542-0100 |
| Fax | 4079927701 |
Authorized person
| Name | DR. JEFFREY G MOSKOWITZ |
| Role | PRESIDENT |
| Phone | 4075420100 |
Taxonomy
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| License Number | ME79584 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 258625800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOSKOWITZ, JEFFREY G | Agent | 143 Mission Road, Oviedo, FL 32765 |
| Name | Role | Address |
|---|---|---|
| Moskowitz, Jeffrey G | Manager | 143 Mission Road, Oviedo, FL 32765 |
| Baumann, Anita | Manager | 143 Mission Road, Oviedo, FL 32765 |
| Name | Role | Address |
|---|---|---|
| Moskowitz, Jeffrey G | Director | 143 Mission Road, Oviedo, FL 32765 |
| Name | Role | Address |
|---|---|---|
| Baumann, Anita | President | 143 Mission Road, Oviedo, FL 32765 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000035547 | OVIEDO DERMPATH | ACTIVE | 2017-04-04 | 2027-12-31 | No data | 143 MISSION ROAD, OVIEDO, FL, 32765 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-28 | 143 Mission Road, Oviedo, FL 32765 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-05-20 | 143 Mission Road, OVIEDO, FL 32765 | No data |
| CHANGE OF MAILING ADDRESS | 2022-05-20 | 143 Mission Road, OVIEDO, FL 32765 | No data |
| LC AMENDMENT AND NAME CHANGE | 2017-02-24 | MOSKOWITZ DERMATOLOGY, M.D., P.L.L.C. | No data |
| LC AMENDMENT AND NAME CHANGE | 2016-08-02 | OVIEDO DERMPATH, P.L.L.C. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-02-06 |
| ANNUAL REPORT | 2017-04-18 |
| LC Amendment and Name Change | 2017-02-24 |
| LC Amendment and Name Change | 2016-08-02 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
