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  5. KENNETH S. JAFFE, M.D. P.A.

KENNETH S. JAFFE, M.D. P.A.

Company Details

Entity Name: KENNETH S. JAFFE, M.D. P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 19 Oct 2000 (24 years ago)
Document Number: P00000099059
FEI/EIN Number 651050544
Address: 130 JFK DRIVE, #134, ATLANTIS, FL, 33462
Mail Address: 130 JFK DRIVE, #134, ATLANTIS, FL, 33462
ZIP code: 33462
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1518210814 2012-10-24 2012-10-24 130 JOHN F KENNEDY DR, SUITE 134, ATLANTIS, FL, 334621141, US 7138 LAKE WORTH RD, LAKE WORTH, FL, 334672970, US

Contacts
Phone +1 561-439-0308
Fax 5614390371

Authorized person
Name DR. KENNETH SCOTT JAFFE
Role PRESIDENT
Phone 5614390308

Taxonomy
Taxonomy Code 207RG0300X - Geriatric Medicine (Internal Medicine) Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 260146000
State FL
Issuer BCBSFL
Number 97340
State FL
Issuer AVMED
Number 269348
State FL
Issuer RAILROAD MEDICARE
Number 110233181
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KENNETH S. JAFFE M. D. , P. A. 401 (K) PLAN 2023 651050544 2024-09-25 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 JFK DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2024-09-25
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-25
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2022 651050544 2023-08-07 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2023-08-07
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2021 651050544 2022-09-13 KENNETH S. JAFFE, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2022-09-13
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2020 651050544 2021-08-11 KENNETH S. JAFFE, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2021-08-11
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2019 651050544 2020-08-19 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2020-08-19
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2018 651050544 2019-04-04 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2019-04-04
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2017 651050544 2018-06-26 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2018-06-26
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2016 651050544 2017-04-07 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2017-04-07
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2015 651050544 2016-04-20 KENNETH S. JAFFE, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature
KENNETH S. JAFFE M.D., P.A. 401(K) PLAN 2014 651050544 2015-07-07 KENNETH S. JAFFE, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 5614390308
Plan sponsor’s address 130 J.F.K. DRIVE, SUITE 134, ATLANTIS, FL, 33462

Signature of
Role Plan administrator
Date 2015-07-07
Name of individual signing KENNETH JAFFE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
COHEN EARL Agent 851 N. DONNELLY ST., MT. DORA, FL, 32757

Director

Name Role Address
JAFFE KENNETH S Director 130 JFK DRIVE SUITE 134, ATLANTIS, FL, 33462

Events

Event Type Filed Date Value Description
CANCEL ADM DISS/REV 2005-10-17 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2005-09-16 No data No data

Related by officers

JAFFE KENNETH S

BR KENZO, LLC A PAIN CLINIC OF DELRAY, INC. DRUG MART PHARMACY, INC. BODY & LIFE, INC. GREEN BR, INC. RYCO MEDICAL, INC. WEST PALM BEACH HOSPITALISTS, LLC KENZO, L.L.C.

COHEN EARL

DAGAN CAPITAL, LLC.

Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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