Provider Demographics
NPI:1780061796
Name:DR. TADEUSZ SZTYKOWSKI INC.
Entity type:Organization
Organization Name:DR. TADEUSZ SZTYKOWSKI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-434-3550
Mailing Address - Street 1:191 NASHUA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1871
Mailing Address - Country:US
Mailing Address - Phone:401-633-0197
Mailing Address - Fax:
Practice Address - Street 1:191 NASHUA ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1871
Practice Address - Country:US
Practice Address - Phone:401-633-0197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07650207Q00000X
RINPP37330363L00000X
RIDA00020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058016Medicaid
RI1548391824OtherNPI
RI1639165004OtherNPI
RI412888OtherBLUE CHIP
RI29913-0OtherBCBS OF RI
RI1972566396OtherNPI
RI007006249Medicare PIN
RI1548391824OtherNPI
RI1639165004OtherNPI