| Name: | Diabetes & Endocrinology Associates, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 30 Apr 1975 (50 years ago) |
| Identification Number: | 000007144 |
| ZIP code: | 02906 |
| County: | Providence County |
| Principal Address: | 100 HIGHLAND AVE SUITE 203, PROVIDENCE, RI, 02906, US |
| Purpose: | PROVIDE MEDICAL SERVICES BY PHYSICIANS |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407954415 | 2006-09-21 | 2015-01-12 | 100 HIGHLAND AVE, PROVIDENCE, RI, 029062740, US | 100 HIGHLAND AVE, PROVIDENCE, RI, 029062740, US | |||||||||||||||||||
|
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| Phone | +1 401-351-7100 |
Authorized person
| Name | CHARLES B KAHN |
| Role | PRESIDENT |
| Phone | 4013517100 |
Taxonomy
| Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9000831 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DENNIS S. KRAUSS, MD | Agent | 100 HIGHLAND AVENUE SUITE 203, PROVIDENCE, RI, 02906, USA |
| Name | Role | Address |
|---|---|---|
| ROBERT J DOBRZYNSKI MD | PRESIDENT | 100 HIGHLAND AVE PROVIDENCE, RI 02906 US |
| Name | Role | Address |
|---|---|---|
| AMAYA HODARKAR MD | TREASURER | 100 HIGHLAND AVE PROVIDENCE, RI 02906 US |
| Name | Role | Address |
|---|---|---|
| MANCHIN CHANG | SECRETARY | 100 HIGHLAND AVE PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| ROBERTO ORTIZ | VICE PRESIDENT | 100 HIGHLAND AVE PROVIDENCE, RI 02906 USA |
| Number | Name | File Date |
|---|---|---|
| 202452304790 | Annual Report | 2024-04-24 |
| 202331956320 | Annual Report | 2023-03-29 |
| 202208726160 | Annual Report | 2022-01-27 |
| 202184359440 | Annual Report | 2021-01-05 |
| 202032765870 | Annual Report | 2020-01-22 |
| 201983966950 | Annual Report | 2019-01-08 |
| 201858275110 | Annual Report | 2018-02-14 |
| 201629205450 | Annual Report | 2016-12-29 |
| 201690840910 | Annual Report | 2016-01-19 |
| 201553408840 | Annual Report | 2015-01-13 |
Date of last update: 05 Oct 2024
Sources: Rhode Island Department of State
