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  5. Thomas R. Walek, M.D., Inc.

Thomas R. Walek, M.D., Inc.

Company Details

Name: Thomas R. Walek, M.D., Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 01 Oct 1987 (37 years ago)
Date of Dissolution: 23 Mar 2017 (8 years ago)
Date of Status Change: 23 Mar 2017 (8 years ago)
Identification Number: 000044392
ZIP code: 02886
County: Kent County
Principal Address: 200 TOLLGATE ROAD SUITE 102, WARWICK, RI, 02886, USA
Purpose: GENERAL PRACTICE OF MEDICINE, INCLUDING THE SPECIALIZING IN PLASTIC, RECONSTRUCTIVE, HAND AND COSMETIC SURGERY
Fictitious names: Cosmetic Surgery of RI (trading name, 1998-05-22 - )
Thomas R. Walek, M.D., PC (trading name, 1998-03-20 - )

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285080945 2016-05-11 2016-05-11 200 TOLL GATE RD, SUITE 102, WARWICK, RI, 028864491, US 200 TOLL GATE RD, SUITE 102, WARWICK, RI, 028864491, US

Contacts
Phone +1 401-738-7659
Fax 4017386425

Authorized person
Name MRS. KAREN MARIE RODRIGUES
Role OFFICE MANAGER
Phone 4017387659

Taxonomy
Taxonomy Code 208200000X - Plastic Surgery Physician
License Number MD05762
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THOMAS R. WALEK, M.D., PC 401(K) PROFIT SHARING PLAN 2012 050432119 2013-06-26 THOMAS R. WALEK, M.D., PC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4017387659
Plan sponsor’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2013-06-26
Name of individual signing THOMAS R. WALEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-26
Name of individual signing THOMAS R. WALEK
Valid signature Filed with authorized/valid electronic signature
THOMAS R. WALEK, M.D., PC 401(K) PROFIT SHARING PLAN 2012 050432119 2013-06-04 THOMAS R. WALEK, M.D., PC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4017387659
Plan sponsor’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2013-06-04
Name of individual signing THOMAS R. WALEK, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-04
Name of individual signing THOMAS R. WALEK, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. WALEK, M.D., PC 401(K) PROFIT SHARING PLAN 2011 050432119 2012-12-28 THOMAS R. WALEK, M.D., PC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4017387659
Plan sponsor’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050432119
Plan administrator’s name THOMAS R. WALEK, M.D., PC
Plan administrator’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886
Administrator’s telephone number 4017387659

Signature of
Role Plan administrator
Date 2012-12-28
Name of individual signing THOMAS R. WALEK, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. WALEK, M.D., PC 401(K) PROFIT SHARING PLAN 2011 050432119 2012-12-28 THOMAS R. WALEK, M.D., PC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4017387659
Plan sponsor’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050432119
Plan administrator’s name THOMAS R. WALEK, M.D., PC
Plan administrator’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886
Administrator’s telephone number 4017387659

Signature of
Role Plan administrator
Date 2012-12-28
Name of individual signing THOMAS R. WALEK, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS R. WALEK, M.D., PC 401(K) PROFIT SHARING PLAN 2011 050432119 2012-12-28 THOMAS R. WALEK, M.D., PC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4017387659
Plan sponsor’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050432119
Plan administrator’s name THOMAS R. WALEK, M.D., PC
Plan administrator’s address 200 TOLLGATE ROAD, SUITE 102, WARWICK, RI, 02886
Administrator’s telephone number 4017387659

Signature of
Role Plan administrator
Date 2012-12-28
Name of individual signing THOMAS R. WALEK, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHN S. PETRONE, ESQ. Agent 1395 ATWOOD AVENUE SUITE 209B, JOHNSTON, RI, 02919, USA

PRESIDENT

Name Role Address
THOMAS R WALEK MD PRESIDENT 200 TOLLGATE ROAD STE 102 WARWICK, RI 02886- USA

Filings

Number Name File Date
201738501630 Articles of Dissolution 2017-03-23
201730865460 Annual Report 2017-01-25
201730093340 Statement of Change of Registered Office by the Registered Agent 2017-01-13
201693529830 Annual Report 2016-03-01
201556617410 Annual Report 2015-03-05
201437793480 Annual Report 2014-03-27
201313487380 Annual Report 2013-03-04
201290618090 Annual Report 2012-02-29
201176301740 Annual Report 2011-03-07
201058150460 Annual Report 2010-02-08

Related by officers

JOHN S. PETRONE, ESQ.

D. Cardi, Inc. CASTER'S INC. PJ REALTY, INC. General Armature Service, Inc. SUBURBAN JEWELRY CO., INC. Raza Hassan, M.D., Inc. Travelers Building Ass'n, Inc. PROVIDENCE CASTING, INC. OSTE Realty, Inc. ANDERSON-WINFIELD FUNERAL HOME INC

Related by address

No related companies by address

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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