Healthcare Provider Details

I. General information

NPI: 1780061796
Provider Name (Legal Business Name): DR. TADEUSZ SZTYKOWSKI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 NASHUA ST
PROVIDENCE RI
02904-1871
US

IV. Provider business mailing address

191 NASHUA ST
PROVIDENCE RI
02904-1871
US

V. Phone/Fax

Practice location:
  • Phone: 401-633-0197
  • Fax:
Mailing address:
  • Phone: 401-633-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDA00020
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD07650
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP37330
License Number StateRI

VIII. Authorized Official

Name: STEPHEN MERRILL
Title or Position: CEO
Credential:
Phone: 401-434-3550