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  5. ROBERT D. SIMON, M.D., P.A.

ROBERT D. SIMON, M.D., P.A.

Company Details

Entity Name: ROBERT D. SIMON, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 06 Apr 2001 (24 years ago)
Date of dissolution: 27 Apr 2017 (8 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 27 Apr 2017 (8 years ago)
Document Number: P01000035358
FEI/EIN Number 651096794
Address: 701 NORTHLAKE BLVD., NORTH PALM BEACH, FL, 33408, US
Mail Address: 701 NORTHLAKE BLVD., Suite 201, NORTH PALM BEACH, FL, 33408, US
ZIP code: 33408
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275665010 2007-03-09 2020-08-22 701 NORTHLAKE BLVD, SUITE 208, NORTH PALM BEACH, FL, 334085215, US 701 NORTHLAKE BLVD, SUITE 208, NORTH PALM BEACH, FL, 334085215, US

Contacts
Phone +1 561-845-7078
Fax 5618478030

Authorized person
Name DR. ROBERT DANIEL SIMON
Role OWNER
Phone 5618457078

Taxonomy
Taxonomy Code 261QM2500X - Medical Specialty Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2015 651096794 2016-10-11 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVRD , SUITE 201, PALM BEACH GARDENS, FL, 334121631

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-11
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2014 651096794 2015-10-15 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 8381 WOODSMUIR DRIVE, PALM BEACH GARDENS, FL, 334121631

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing ROBERT D. SIMON, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-15
Name of individual signing ROBERT D. SIMON, MD
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2013 651096794 2014-10-15 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-15
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2012 651096794 2013-12-24 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215

Signature of
Role Plan administrator
Date 2013-12-24
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-12-24
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2011 651096794 2013-01-09 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215

Plan administrator’s name and address
Administrator’s EIN 651096794
Plan administrator’s name ROBERT D. SIMON, M.D., P.A.
Plan administrator’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215
Administrator’s telephone number 5618457078

Signature of
Role Plan administrator
Date 2013-01-09
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-01-09
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2010 651096794 2011-10-17 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215

Plan administrator’s name and address
Administrator’s EIN 651096794
Plan administrator’s name ROBERT D. SIMON, M.D., P.A.
Plan administrator’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215
Administrator’s telephone number 5618457078

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
ROBERT D. SIMON, M.D., P.A., 401(K) PROFIT SHARING PLAN 2009 651096794 2010-10-15 ROBERT D. SIMON, M.D., P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5618457078
Plan sponsor’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215

Plan administrator’s name and address
Administrator’s EIN 651096794
Plan administrator’s name ROBERT D. SIMON, M.D., P.A.
Plan administrator’s address 701 NORTHLAKE BOULEVARD, #208, NORTH PALM BEACH, FL, 334085215
Administrator’s telephone number 5618457078

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-15
Name of individual signing ROBERT SIMON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SIMON ROBERT D Agent 701 NORTHLAKE BLVD., NORTH PALM BEACH, FL, 33408

President

Name Role Address
SIMON ROBERT D President 701 NORTHLAKE BLVD., NORTH PALM BEACH, FL, 33408

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2017-04-27 No data No data
CHANGE OF PRINCIPAL ADDRESS 2014-04-15 701 NORTHLAKE BLVD., Suite 201, NORTH PALM BEACH, FL 33408 No data
CHANGE OF MAILING ADDRESS 2014-04-15 701 NORTHLAKE BLVD., Suite 201, NORTH PALM BEACH, FL 33408 No data
REGISTERED AGENT ADDRESS CHANGED 2014-04-15 701 NORTHLAKE BLVD., Suite 201, NORTH PALM BEACH, FL 33408 No data
CANCEL ADM DISS/REV 2010-01-25 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 No data No data
REGISTERED AGENT NAME CHANGED 2006-02-03 SIMON, ROBERT DPRES No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J10000914835 LAPSED 1000000184962 PALM BEACH 2010-08-19 2020-09-15 $ 971.90 STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105

Documents

Name Date
ANNUAL REPORT 2016-03-22
ANNUAL REPORT 2015-02-09
ANNUAL REPORT 2014-04-15
ANNUAL REPORT 2013-01-14
ANNUAL REPORT 2012-04-27
ANNUAL REPORT 2011-04-29
REINSTATEMENT 2010-01-25
ANNUAL REPORT 2008-02-29
ANNUAL REPORT 2007-02-07
ANNUAL REPORT 2006-02-03

Related by officers

SIMON ROBERT D

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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