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  5. DAVID A. LICKSTEIN, M.D., P.A.

DAVID A. LICKSTEIN, M.D., P.A.

Company Details

Entity Name: DAVID A. LICKSTEIN, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 30 Jun 2005 (20 years ago)
Date of dissolution: 13 Feb 2020 (5 years ago)
Last Event: CONVERSION
Event Date Filed: 13 Feb 2020 (5 years ago)
Document Number: P05000093620
FEI/EIN Number 203094584
Address: 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418, US
Mail Address: 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418, US
ZIP code: 33418
County: Palm Beach
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2021 203094584 2022-06-21 DAVID A. LICKSTEIN, M.D., P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2022-06-21
Name of individual signing LISA LICKSTEIN
Valid signature Filed with authorized/valid electronic signature
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2020 203094584 2021-08-01 DAVID A. LICKSTEIN, M.D., P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2019 203094584 2020-10-09 DAVID A. LICKSTEIN, M.D., P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2018 203094584 2019-07-25 DAVID A. LICKSTEIN, M.D., P.A. 14
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2018 203094584 2019-09-13 DAVID A. LICKSTEIN, M.D., P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418
LICKSTEIN PLASTIC SURGERY 401(K) PLAN 2017 203094584 2018-07-27 DAVID A. LICKSTEIN, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621399
Sponsor’s telephone number 5615714000
Plan sponsor’s address 5540 PGA BOULEVARD, SUITE 200, PALM BEACH GARDENS, FL, 33418

Agent

Name Role Address
Lesser Gary Agent 101 NORTHPOINT PARKWAY, WEST PALM BEACH, FL, 33407

Director

Name Role Address
LICKSTEIN DAVID AMD Director 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418

President

Name Role Address
LICKSTEIN DAVID AMD President 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418

Secretary

Name Role Address
LICKSTEIN DAVID AMD Secretary 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418

Treasurer

Name Role Address
LICKSTEIN DAVID AMD Treasurer 5540 PGA Boulevard, PALM BEACH GARDENS, FL, 33418

Events

Event Type Filed Date Value Description
CONVERSION 2020-02-13 No data CONVERSION MEMBER. RESULTING CORPORATION WAS L20000068988. CONVERSION NUMBER 300000200703
REGISTERED AGENT NAME CHANGED 2018-04-14 Lesser, Gary No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-14 101 NORTHPOINT PARKWAY, WEST PALM BEACH, FL 33407 No data
CHANGE OF PRINCIPAL ADDRESS 2017-01-22 5540 PGA Boulevard, Suite 200, PALM BEACH GARDENS, FL 33418 No data
CHANGE OF MAILING ADDRESS 2017-01-22 5540 PGA Boulevard, Suite 200, PALM BEACH GARDENS, FL 33418 No data

Documents

Name Date
ANNUAL REPORT 2020-02-03
ANNUAL REPORT 2019-03-02
ANNUAL REPORT 2018-04-14
ANNUAL REPORT 2017-01-22
ANNUAL REPORT 2016-02-09
ANNUAL REPORT 2015-02-22
ANNUAL REPORT 2014-02-28
ANNUAL REPORT 2013-01-28
ANNUAL REPORT 2012-04-25
ANNUAL REPORT 2011-04-18

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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