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  5. JEFFREY ROTHSTEIN, D.O., P.A.

JEFFREY ROTHSTEIN, D.O., P.A.

Company Details

Entity Name: JEFFREY ROTHSTEIN, D.O., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 03 Feb 1992 (33 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 13 Dec 1996 (28 years ago)
Document Number: V12524
FEI/EIN Number 65-0322309
Address: 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021
Mail Address: 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021
ZIP code: 33021
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1326014762 2006-02-26 2007-11-29 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL, 330213564, US 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL, 330213564, US

Contacts
Phone +1 954-963-6530
Fax 9549638587

Authorized person
Name DR. JEFFREY ROTHSTEIN
Role PRESIDENT
Phone 9549636530

Taxonomy
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2022 650322309 2023-10-12 JEFFREY ROTHSTEIN, D.O.,P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-12
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2021 650322309 2022-10-17 JEFFREY ROTHSTEIN, D.O.,P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2020 650322309 2021-09-29 JEFFREY ROTHSTEIN, D.O.,P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2019 650322309 2020-10-14 JEFFREY ROTHSTEIN, D.O.,P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2018 650322309 2019-10-15 JEFFREY ROTHSTEIN, D.O.,P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-15
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2017 650322309 2018-07-09 JEFFREY ROTHSTEIN, D.O.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2018-07-09
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2016 650322309 2017-09-27 JEFFREY ROTHSTEIN, D.O.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2017-09-27
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-27
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
401(K) FOR JEFFREY ROTHSTEIN, D. O. , P. A. 2015 650322309 2016-05-25 JEFFREY ROTHSTEIN, D.O.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9549636530
Plan sponsor’s address 4030 SHERIDAN STREET, SUITE A, HOLLYWOOD, FL, 33021

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-25
Name of individual signing JEFFREY ROTHSTEIN
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
ROTHSTEIN, JEFFREY P Agent 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021

President

Name Role Address
ROTHSTEIN, JEFFREY, Dr. President 4030 SHERIDAN ST, SUITE A HOLLYWOOD, FL 33021

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2013-01-28 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021 No data
CHANGE OF MAILING ADDRESS 2005-07-04 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021 No data
REGISTERED AGENT NAME CHANGED 2005-07-04 ROTHSTEIN, JEFFREY P No data
REGISTERED AGENT ADDRESS CHANGED 2005-07-04 4030 SHERIDAN ST, SUITE A, HOLLYWOOD, FL 33021 No data
REINSTATEMENT 1996-12-13 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1996-08-23 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-22
ANNUAL REPORT 2023-01-25
ANNUAL REPORT 2022-01-24
ANNUAL REPORT 2021-03-03
ANNUAL REPORT 2020-02-17
ANNUAL REPORT 2019-04-03
ANNUAL REPORT 2018-01-09
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-01-26
ANNUAL REPORT 2015-01-26

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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