| Entity Name: | JEFFREY S GORODETSKY, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Oct 2005 (19 years ago) |
| Date of dissolution: | 02 Feb 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 02 Feb 2017 (8 years ago) |
| Document Number: | P05000141541 |
| FEI/EIN Number | 550907821 |
| Address: | 2581 SW Racquet Club Drive, Palm City, FL, 34990, US |
| Mail Address: | PO Box 2333, STUART, FL, 34995, US |
| ZIP code: | 34990 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811186653 | 2007-10-17 | 2012-09-17 | 433 E OCEAN BLVD, STUART, FL, 349942573, US | 433 E OCEAN BLVD, STUART, FL, 349942573, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-223-4504 |
| Fax | 7722235988 |
Authorized person
| Name | DR. JEFFREY S GORODETSKY |
| Role | PRESIDENT |
| Phone | 7722234504 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | ME0053894 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 07463 |
| State | FL |
| Issuer | RAILROAD MEDICARE |
| Number | P00307631 |
| State | FL |
| Issuer | MEDICAID |
| Number | 048745701 |
| State | FL |
| Issuer | MEDICARE INDIVIDUAL |
| Number | 07463P |
| State | FL |
| Issuer | MEDICACE GROUP |
| Number | K9632 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GORODETSKY JEFFREY S | Agent | 2581 SW Racquet Club Drive, Palm City, FL, 34990 |
| Name | Role | Address |
|---|---|---|
| GORODETSKY JEFFREY S | President | 2581 SW Racquet Club Drive, Palm City, FL, 34990 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-02-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-02 | 2581 SW Racquet Club Drive, Palm City, FL 34990 | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-02 | 2581 SW Racquet Club Drive, Palm City, FL 34990 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-02 | 2581 SW Racquet Club Drive, Palm City, FL 34990 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2017-02-02 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-01-11 |
| ANNUAL REPORT | 2014-01-11 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-03-29 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-02-18 |
| ANNUAL REPORT | 2009-06-25 |
| ANNUAL REPORT | 2008-04-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
