1780061796 NPI number — DR. TADEUSZ SZTYKOWSKI INC.

Table of content: (NPI 1780061796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780061796 NPI number — DR. TADEUSZ SZTYKOWSKI INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. TADEUSZ SZTYKOWSKI INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTERS FOR INTEGRATIVE MEDICINE AND HEALING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780061796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 NASHUA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02904-1871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-633-0197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 NASHUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-633-0197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MERRILL
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
401-434-3550

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  DA00020 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD07650 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: NPP37330 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7058016 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548391824 . This is a "NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1639165004 . This is a "NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 412888 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 29913-0 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1972566396 . This is a "NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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