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  5. HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.

HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.

Company Details

Name: HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 11 Jun 1984 (41 years ago)
Date of Dissolution: 18 Jul 2019 (6 years ago)
Date of Status Change: 18 Jul 2019 (6 years ago)
Identification Number: 000019746
ZIP code: 02860
County: Providence County
Principal Address: 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860, USA
Purpose: PROFESSIONAL SERVICES IN MEDICINE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Historical names: Rhode Island Hematology-Oncology, Ltd.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1861613200 2007-05-02 2010-07-06 73 BEECHWOOD AVE, PAWTUCKET, RI, 028605409, US 73 BEECHWOOD AVE, PAWTUCKET, RI, 028605409, US

Contacts
Phone +1 401-724-4040
Fax 4017229575

Authorized person
Name DR. DAVID BRUCE ETTENSOHN
Role VICE PRESIDENT
Phone 4017244040

Taxonomy
Taxonomy Code 207RC0200X - Critical Care Medicine (Internal Medicine) Physician
License Number 6164
State RI
Is Primary No
Taxonomy Code 207RC0200X - Critical Care Medicine (Internal Medicine) Physician
License Number 9817
State RI
Is Primary No
Taxonomy Code 207RH0003X - Hematology & Oncology Physician
License Number 6245
State RI
Is Primary No
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
License Number 6164
State RI
Is Primary No
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
License Number 9817
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2018 050407785 2019-08-12 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2018 050407785 2019-08-02 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2017 050407785 2018-06-07 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2016 050407785 2017-03-17 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2015 050407785 2016-09-12 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2014 050407785 2015-07-16 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing DAVID B. ETTENSOHN
Valid signature Filed with authorized/valid electronic signature
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2013 050407785 2014-03-19 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2014-03-19
Name of individual signing DAVID B. ETTENSOHN
Valid signature Filed with authorized/valid electronic signature
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2012 050407785 2013-07-22 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2013-07-22
Name of individual signing DAVID B. ETTENSOHN
Valid signature Filed with authorized/valid electronic signature
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2011 050407785 2012-10-15 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing DAVID B. ETTENSOHN
Valid signature Filed with authorized/valid electronic signature
HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. PROFIT SHARING PLAN 2010 050407785 2011-09-26 HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2011-09-26
Name of individual signing LINDA R. HASSAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/07/20101007175818P070015097633001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1984-04-01
Business code 621111
Sponsor’s telephone number 4017285900
Plan sponsor’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050407785
Plan administrator’s name HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.
Plan administrator’s address 73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017285900

Signature of
Role Plan administrator
Date 2010-10-07
Name of individual signing LINDA R. HASSAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARTIN P. SLEPKOW, ESQ. Agent 1481 WAMPANOAG TRAIL, EAST PROVIDENCE, RI, 02915, USA

PRESIDENT

Name Role Address
LINDA R HASSAN PRESIDENT 73 BEECHWOOD AVENUE PAWTUCKET, RI 02860 USA

Events

Type Date Old Value New Value
Name Change 1999-01-01 Rhode Island Hematology-Oncology, Ltd. HASSAN-ETTENSOHN MEDICAL SPECIALISTS, LTD.

Filings

Number Name File Date
201905408560 Annual Report 2019-07-18
201905409350 Articles of Dissolution 2019-07-18
201857907300 Annual Report 2018-02-08
201734101050 Annual Report 2017-02-13
201692094410 Annual Report 2016-02-08
201555602570 Annual Report 2015-02-23
201434559430 Annual Report 2014-01-30
201313506180 Annual Report 2013-03-04
201289237330 Annual Report 2012-02-08
201173990820 Annual Report 2011-01-24

Related by officers

MARTIN P. SLEPKOW, ESQ.

ACCESS DEVELOPMENT CORPORATION BARLOW DESIGNS, INC. BAY BICYCLE COMPANY BULLOCKS POINT REALTY, INC. CRONIN ASPHALT CORP. JOSEPH P. CUDDIGAN PLUMBING CO. ALAN CORPORATION The Galen Corp. METRIC MASTERS, INC. EAST PROVIDENCE CYCLE CO.

LINDA R HASSAN

KRISTEN M. ETTENSOHN SCHOLARSHIP FUND

Related by address

73 BEECHWOOD AVENUE, PAWTUCKET, RI, 02860, USA

PAWTUCKET PULMONARY FUNCTION TESTING, LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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