| Entity Name: | PETER A. VITULLI JR., D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Apr 2003 (22 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 16 Feb 2010 (15 years ago) |
| Document Number: | P03000044274 |
| FEI/EIN Number | 510462246 |
| Address: | 4600 MILITARY TRAIL, # 107, JUPITER, FL, 33458 |
| Mail Address: | 4600 MILITARY TRAIL, #107, JUPITER, FL, 33458 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306012745 | 2008-05-06 | 2012-09-28 | 4600 MILITARY TRL, SUITE 107, JUPITER, FL, 334584810, US | 4600 MILITARY TRL, SUITE 107, JUPITER, FL, 334584810, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 561-427-2000 |
| Fax | 5617762565 |
Authorized person
| Name | PETER A VITULLI JR. |
| Role | PHYSICIAN/CEO |
| Phone | 5614272000 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | OS8005 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE- ID TYPE |
| Number | 81700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VITULLI PETER A | Agent | 4600 MILITARY TRAIL, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| VITULLI PETER A | President | 4600 MILITARY TRAIL, JUPITER, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-29 | 4600 MILITARY TRAIL, # 107, JUPITER, FL 33458 | No data |
| CHANGE OF MAILING ADDRESS | 2012-05-15 | 4600 MILITARY TRAIL, # 107, JUPITER, FL 33458 | No data |
| CANCEL ADM DISS/REV | 2010-02-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-02-21 | 4600 MILITARY TRAIL, # 107, JUPITER, FL 33458 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-27 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
