| Entity Name: | JAY S. MENDELSOHN, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 15 Mar 1990 (35 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | L57437 |
| FEI/EIN Number | 65-0182554 |
| Address: | 3230 STIRLING ROAD, HOLLYWOOD, FL 33021 |
| Mail Address: | 3230 STIRLING ROAD, HOLLYWOOD, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033201306 | 2006-09-28 | 2009-10-30 | 3230 STIRLING RD, SUITE #3, HOLLYWOOD, FL, 33021, US | 3230 STIRLING RD, SUITE #3, HOLLYWOOD, FL, 33021, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-963-5000 |
| Fax | 9549635077 |
Authorized person
| Name | JAY SHERMAN MENDELSOHN |
| Role | PRESIDENT |
| Phone | 9549635000 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME0040148 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME0063435 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME0073257 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 253674900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GERSON,PRESTON,ROBINSON&CO,PA | Agent | 666 SEVENTY-FIRST STREET, MIAMI BEACH,, FL 33141 |
| Name | Role | Address |
|---|---|---|
| MENDELSOHN, JAY S | President | 3230 STIRLING RD, HOLLYWOOD, FL |
| Name | Role | Address |
|---|---|---|
| MENDELSOHN, JAY S | Secretary | 3230 STIRLING RD, HOLLYWOOD, FL |
| Name | Role | Address |
|---|---|---|
| MENDELSOHN, JAY S | Treasurer | 3230 STIRLING RD, HOLLYWOOD, FL |
| Name | Role | Address |
|---|---|---|
| MENDELSOHN, JAY S | Director | 3230 STIRLING RD, HOLLYWOOD, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| AMENDMENT | 2013-11-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-02-09 | GERSON,PRESTON,ROBINSON&CO,PA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-09 | 666 SEVENTY-FIRST STREET, MIAMI BEACH,, FL 33141 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1992-05-15 | 3230 STIRLING ROAD, HOLLYWOOD, FL 33021 | No data |
| CHANGE OF MAILING ADDRESS | 1992-05-15 | 3230 STIRLING ROAD, HOLLYWOOD, FL 33021 | No data |
| Name | Date |
|---|---|
| Off/Dir Resignation | 2013-11-21 |
| Amendment | 2013-11-19 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-03-27 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-02-16 |
| ANNUAL REPORT | 2009-02-09 |
| ANNUAL REPORT | 2008-03-24 |
| ANNUAL REPORT | 2007-02-14 |
| ANNUAL REPORT | 2006-03-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
