| Entity Name: | EJMD, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Aug 2021 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 03 Jan 2022 (3 years ago) |
| Document Number: | L21000389610 |
| FEI/EIN Number | 87-2763592 |
| Address: | 3801 PGA Blvd, Palm Beach Gardens, FL, 33410, US |
| Mail Address: | 3801 PGA Blvd, Palm Beach Gardens, FL, 33410, US |
| ZIP code: | 33410 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356039317 | 2023-04-27 | 2023-12-27 | 3801 PGA BLVD STE 600, PALM BEACH GARDENS, FL, 334102756, US | 3801 PGA BLVD STE 600, PALM BEACH GARDENS, FL, 334102756, US | |||||||||||||
|
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| Phone | +1 561-815-9791 |
Authorized person
| Name | DR. EVAN L JACOBSON |
| Role | PSYCHIATRIST |
| Phone | 5618159791 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JACOBSON EVAN | Agent | 3801 PGA Blvd, Palm Beach Gardens, FL, 33410 |
| Name | Role | Address |
|---|---|---|
| JACOBSON EVAN | Managing Member | 3801 PGA Blvd, Palm Beach Gardens, FL, 33410 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000086502 | EJMD, PLLC DBA FAIRWAY PSYCHIATRY | ACTIVE | 2022-07-21 | 2027-12-31 | No data | 3801 PGA BLVD,SUITE 600, PALM BEACH GARDENS, FL, 33410 |
| G21000126696 | EJMD, PLLC DBA EJMD PSYCHIATRY OF PALM BEACH | ACTIVE | 2021-09-22 | 2026-12-31 | No data | 217 BLESSED ISLES LANE, JUPITER, FL, 33478 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-05 | 3801 PGA Blvd, Suite 600, Palm Beach Gardens, FL 33410 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-05 | 3801 PGA Blvd, Suite 600, Palm Beach Gardens, FL 33410 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-05 | 3801 PGA Blvd, Suite 600, Palm Beach Gardens, FL 33410 | No data |
| LC AMENDMENT | 2022-01-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-09 |
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-04-12 |
| LC Amendment | 2022-01-03 |
| Florida Limited Liability | 2021-08-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
