| Name: | Dr. Tadeusz Sztykowski, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 05 Apr 1995 (30 years ago) |
| Date of Dissolution: | 30 Dec 2020 (4 years ago) |
| Date of Status Change: | 30 Dec 2020 (4 years ago) |
| Identification Number: | 000083732 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 191 NASHUA STREET, PROVIDENCE, RI, 02904, USA |
| Purpose: | ALTERNATIVE MEDICINE CLINIC SPECIALIZING IN ACUPUNCTURE |
| Fictitious names: |
Centers for Integrative Medicine and Healing (trading name, 2014-01-17 - ) CENTER FOR PREVENTIVE MEDICINE (trading name, 2009-08-28 - ) |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1780061796 | 2015-04-28 | 2015-04-28 | 191 NASHUA ST, PROVIDENCE, RI, 029041871, US | 191 NASHUA ST, PROVIDENCE, RI, 029041871, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-633-0197 |
Authorized person
| Name | STEPHEN MERRILL |
| Role | CEO |
| Phone | 4014343550 |
Taxonomy
| Taxonomy Code | 171100000X - Acupuncturist |
| License Number | DA00020 |
| State | RI |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD07650 |
| State | RI |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| License Number | NPP37330 |
| State | RI |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 7058016 |
| State | RI |
| Issuer | NPI |
| Number | 1548391824 |
| State | RI |
| Issuer | NPI |
| Number | 1639165004 |
| State | RI |
| Issuer | BLUE CHIP |
| Number | 412888 |
| State | RI |
| Issuer | BCBS OF RI |
| Number | 29913-0 |
| State | RI |
| Issuer | NPI |
| Number | 1972566396 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| BRANDON PHILIP NOWAK | Agent | 191 NASHUA STREET, PROVIDENCE, RI, 02904, USA |
| Name | Role | Address |
|---|---|---|
| TADEUSZ SZTYKOWSKI | PRESIDENT | 191 NASHUA STREET PROVIDENCE, RI 02904 USA |
| Number | Name | File Date |
|---|---|---|
| 202082831200 | Revocation Certificate For Failure to File the Annual Report for the Year | 2020-12-30 |
| 202054986880 | Revocation Notice For Failure to File An Annual Report | 2020-09-16 |
| 201912252730 | Statement of Change of Registered/Resident Agent | 2019-08-13 |
| 201882172380 | Statement of Change of Registered/Resident Agent | 2018-12-04 |
| 201880476930 | Annual Report | 2018-10-30 |
| 201880478150 | Annual Report | 2018-10-30 |
| 201875458240 | Revocation Notice For Failure to File An Annual Report | 2018-08-24 |
| 201734207680 | Annual Report | 2017-02-16 |
| 201693413030 | Annual Report | 2016-02-29 |
| 201557263580 | Annual Report | 2015-03-12 |
Date of last update: 09 Apr 2025
Sources: Rhode Island Department of State
