| Entity Name: | ANDREW GREENBERG MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Sep 2010 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Mar 2022 (3 years ago) |
| Document Number: | P10000073304 |
| FEI/EIN Number | 27-3415386 |
| Address: | 12098 orange ave, Fort Pierce, FL, 34945, US |
| Mail Address: | 12098 orange ave, Fort Pierce, FL, 34945, US |
| ZIP code: | 34945 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679880561 | 2010-09-13 | 2010-09-13 | 4617 EL MAR DR, LAUDERDALE BY THE SEA, FL, 333083635, US | 4617 EL MAR DR, LAUDERDALE BY THE SEA, FL, 333083635, US | |||||||||||||||||||||||||
|
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| Phone | +1 631-827-7415 |
| Fax | 9547712955 |
Authorized person
| Name | ANDREW GREENBERG |
| Role | PRESIDENT |
| Phone | 6318277415 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME100693 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL MED LIC |
| Number | ME100693 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Greenberg Andrew MD | Agent | 12098 orange ave, Fort Pierce, FL, 34945 |
| Name | Role | Address |
|---|---|---|
| GREENBERG ANDREW | President | 12098 orange ave, Fort Pierce, FL, 34945 |
| Name | Role | Address |
|---|---|---|
| GREENBERG ANDREW | Treasurer | 12098 orange ave, Fort Pierce, FL, 34945 |
| Name | Role | Address |
|---|---|---|
| GREENBERG ANDREW | Secretary | 12098 orange ave, Fort Pierce, FL, 34945 |
| Name | Role | Address |
|---|---|---|
| GREENBERG ANDREW | Director | 12098 orange ave, Fort Pierce, FL, 34945 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-03-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-02 | 12098 orange ave, Fort Pierce, FL 34945 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-02 | 12098 orange ave, Fort Pierce, FL 34945 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-02 | Greenberg, Andrew, MD | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-02 | 12098 orange ave, Fort Pierce, FL 34945 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14001143154 | TERMINATED | 1000000637624 | BROWARD | 2014-07-31 | 2034-12-17 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, FORT PIERCE SERVICE CENTER, 337 N US HIGHWAY 1 STE 207-B, FORT PIERCE FL349504255 |
| J13000846452 | TERMINATED | 1000000419998 | BROWARD | 2013-04-29 | 2033-05-03 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, FORT PIERCE SERVICE CENTER, 337 N US HIGHWAY 1 STE 207-B, FORT PIERCE FL349504255 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-02 |
| ANNUAL REPORT | 2023-02-25 |
| REINSTATEMENT | 2022-03-02 |
| Domestic Profit | 2010-09-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
