| Entity Name: | PETRYCHENKO PAIN MANAGEMENT PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 Jun 2021 (4 years ago) |
| Document Number: | P21000051440 |
| FEI/EIN Number | 87-1024552 |
| Address: | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 |
| Mail Address: | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 |
| ZIP code: | 33009 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841860442 | 2021-06-28 | 2021-06-28 | 2100 E HALLANDALE BEACH BLVD STE 210, HALLANDALE BEACH, FL, 330093770, US | 2100 E HALLANDALE BEACH BLVD STE 210, HALLANDALE BEACH, FL, 330093770, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 212-951-1238 |
| Fax | 7183365137 |
Authorized person
| Name | DR. DMITRI PETRYCHENKO |
| Role | PRESIDENT |
| Phone | 9293207481 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PETRYCHENKO, DMITRI | Agent | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 |
| Name | Role | Address |
|---|---|---|
| PETRYCHENKO, DMITRI | President | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-27 | PETRYCHENKO, DMITRI | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-28 | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-28 | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-28 | 2100 E HALLANDALE BEACH BLVD #210, HALLANDALE BEACH, FL 33009 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-05-04 |
| ANNUAL REPORT | 2022-02-28 |
| Domestic Profit | 2021-06-01 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
