| Entity Name: | EDMUND A. GELLER, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Nov 1993 (31 years ago) |
| Document Number: | P93000081103 |
| FEI/EIN Number | 65-0456258 |
| Address: | 1 SW 129 AVE, 200, PEMBROKE PINES, FL, 33027, US |
| Mail Address: | 1 SW 129 AVE, 200, PEMBROKE PINES, FL, 33027, US |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083885727 | 2008-03-21 | 2008-06-23 | 1 SW 129TH AVE, SUITE 200, PEMBROKE PINES, FL, 330271761, US | 1 SW 129TH AVE, SUITE 200, PEMBROKE PINES, FL, 330271761, US | |||||||||||||||||||
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| Phone | +1 954-437-7358 |
| Fax | 9544374197 |
Authorized person
| Name | EDMUND A GELLER |
| Role | OWNER |
| Phone | 9544377358 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME39306 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EDMUND A. GELLER, M.D., P.A. PENSION PLAN | 2010 | 650456258 | 2011-02-24 | EDMUND A. GELLER, M.D., P.A. | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650456258 |
| Plan administrator’s name | EDMUND A. GELLER, M.D., P.A. |
| Plan administrator’s address | 1 SW 129TH AVENUE, SUITE 200, PEMBROKE PINES, FL, 33027 |
| Administrator’s telephone number | 9544377358 |
Signature of
| Role | Plan administrator |
| Date | 2011-02-24 |
| Name of individual signing | EDMUND GELLER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GELLER EDMUND A | Agent | 1 SW 129TH AVE, PEMBROKE PINES, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| GELLER EDMUND A | President | 1 SW 129TH AVE, PEMBROKE PINES, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-02-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
