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  5. BENEZRA GYNECOLOGY LLC

BENEZRA GYNECOLOGY LLC

Company Details

Entity Name: BENEZRA GYNECOLOGY LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Company
Status: Active
Date Filed: 28 Feb 2018 (7 years ago)
Document Number: M18000002082
FEI/EIN Number 82-4368281
Address: 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901
Mail Address: 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901
ZIP code: 32901
County: Brevard
Place of Formation: WYOMING

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225537731 2018-02-09 2018-11-30 129 W HIBISCUS BOULEVARD SUITE A, MELBOURNE, FL, 329013006, US 129 W HIBISCUS BLVD, STE A, MELBOURNE, FL, 32901, US

Contacts
Phone +1 321-405-3000
Fax 3217227070

Authorized person
Name DR. VICTOR BENEZRA
Role PHYSICIAN
Phone 3059757407

Taxonomy
Taxonomy Code 207VG0400X - Gynecology Physician
License Number ME89256
State FL
Is Primary Yes

Other Provider Identifiers
Issuer FLORIDA BLUE
Number 1QMNM
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2023 824368281 2024-05-03 BENEZRA GYNECOLOGY 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2024-05-03
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2022 824368281 2023-04-07 BENEZRA GYNECOLOGY 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2023-04-07
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2021 824368281 2022-05-24 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2022-05-24
Name of individual signing WRAY BENEZRA
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2020 824368281 2021-04-03 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2021-04-03
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2019 824368281 2020-04-09 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2020-04-09
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BENEZRA, VICTOR Agent 650 S RIVERSIDE DR, INDIALANTIC, FL 32903

Manager

Name Role Address
BENEZRA, VICTOR Manager 650 S RIVERSIDE DR, INDIALANTIC, FL 32903

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000047888 BENEZRA WOMEN'S CARE, LLC ACTIVE 2018-04-14 2028-12-31 No data 650 S RIVERSIDE DRIVE, INDIALANTIC, FL, 32903

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-04-23 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901 No data
CHANGE OF MAILING ADDRESS 2018-04-23 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901 No data

Documents

Name Date
ANNUAL REPORT 2025-01-15
ANNUAL REPORT 2024-01-16
ANNUAL REPORT 2023-01-20
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-02-09
ANNUAL REPORT 2020-03-29
ANNUAL REPORT 2019-02-11
Foreign Limited 2018-02-28

Related by officers

BENEZRA, VICTOR

BEAUTYGYN, LLC GIJOVIC, LLC RBX3, LLC. XMIMA, LLC BENEZRA REAL ESTATE, LLC

Related by address

No related companies by address

Date of last update: 18 Jan 2025

Sources: Florida Department of State

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