| Entity Name: | AMOL K GUPTA MD CORPORATION |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jul 2007 (18 years ago) |
| Document Number: | P07000084211 |
| FEI/EIN Number | 260598821 |
| Address: | 345 CLYDE MORRIS BLVD, SUITE #390, ORMOND BEACH, FL, 32174 |
| Mail Address: | 345 CLYDE MORRIS BLVD, SUITE #390, ORMOND BEACH, FL, 32174 |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710162094 | 2008-01-04 | 2008-03-03 | 345 CLYDE MORRIS BLVD, STE 390, ORMOND BEACH, FL, 321743111, US | 345 CLYDE MORRIS BLVD, STE 390, ORMOND BEACH, FL, 321743111, US | |||||||||||||||||||
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| Phone | +1 386-673-0075 |
| Fax | 3866730049 |
Authorized person
| Name | DR. AMOL K GUPTA |
| Role | OWNER |
| Phone | 3866730075 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME97749 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AMOL K GUPTA MD CORPORATION 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 260598821 | 2024-05-06 | AMOL K GUPTA MD CORPORATION | 6 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 471637791 |
| Plan administrator’s name | ERISA FIDUCIARY SERVICES, INC. |
| Plan administrator’s address | 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
| Administrator’s telephone number | 6312490500 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-06 |
| Name of individual signing | ERISA FIDUCIARY SERVICES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 3866730075 |
| Plan sponsor’s address | 345 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 321743111 |
Plan administrator’s name and address
| Administrator’s EIN | 471637791 |
| Plan administrator’s name | ERISA FIDUCIARY SERVICES, INC. |
| Plan administrator’s address | 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
| Administrator’s telephone number | 6312490500 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-01 |
| Name of individual signing | AMOL K GUPTA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GUPTA AMOL K | Agent | 345 CLYDE MORRIS BLVD, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| GUPTA AMOL K | President | 4 Waterfront Ct, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| GUPTA SHEILA R | Vice President | 4 WATERFRONT CT, ORMOND BEACH, FL, 32174 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08002900284 | GUPTA SPORTS AND SPINE CENTER | ACTIVE | 2008-01-02 | 2028-12-31 | No data | 345 CLYDE MORRIS BLVD, SUITE 390, ORMOND BEACH, FL, 32174 |
| G07312900230 | GUPTA MEDICAL SPECIALISTS | ACTIVE | 2007-11-08 | 2027-12-31 | No data | 345 CLYDE MORRIS BLVD, SUITE 390, ORMOND BEACH, FL, 32174 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-03-15 |
| ANNUAL REPORT | 2018-02-18 |
| ANNUAL REPORT | 2017-03-08 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
