| Entity Name: | WEST PALM BEACH NEUROLOGY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Jan 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 18 May 2020 (5 years ago) |
| Document Number: | P04000021688 |
| FEI/EIN Number | 412124483 |
| Address: | 2287 STOTESBURY WAY, WELLINGTON, FL, 33414, US |
| Mail Address: | 2287 STOTESBURY WAY, WELLINGTON, FL, 33414, US |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730299272 | 2006-08-30 | 2013-01-07 | 1035 S STATE ROAD 7 STE 214, WELLINGTON, FL, 334146137, US | 1035 S STATE ROAD 7 STE 214, WELLINGTON, FL, 334146137, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 561-422-1006 |
| Fax | 5614221078 |
Authorized person
| Name | JAMAL ABDEL-HALIM |
| Role | PRESIDENT/OWNER |
| Phone | 5614221006 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME85753 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Number | 51436 |
| State | FL |
| Issuer | MEDICAID |
| Number | 265548900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ABDEL-HALIM, M.D. JAMAL MOHAMMAD | Agent | 2287 STOTESBURY WAY, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| ABDEL-HALIM, M.D. JAMAL MOHAMMAD | Manager | 2287 STOTESBURY WAY, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| ABDEL-HALIM, M.D. JAMAL MOHAMMAD | Director | 2287 STOTESBURY WAY, WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2020-05-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-16 | 2287 STOTESBURY WAY, WELLINGTON, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-16 | 2287 STOTESBURY WAY, WELLINGTON, FL 33414 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-16 | 2287 STOTESBURY WAY, WELLINGTON, FL 33414 | No data |
| AMENDMENT | 2016-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-03-15 |
| Amendment | 2020-05-18 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-03-28 |
| Amendment | 2016-09-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
