| 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 |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Fictitious names: |
Centers for Integrative Medicine and Healing (trading name, 2014-01-17 - ) CENTER FOR PREVENTIVE MEDICINE (trading name, 2009-08-28 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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: 07 Oct 2024
Sources: Rhode Island Department of State
