Bogursky, Sondra Iacullo

Bogursky, Sondra Iacullo is an individual health care provider with primary practice located at 95 Scovill St 3Rd Floor, Waterbury CT 06706-1113. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Bogursky, Sondra Iacullo can be contacted via phone (203) 709-3800.

Contact Information

Primary practice address
95 Scovill St 3Rd Floor Waterbury CT 06706-1113
Phone: (203) 709-3800
Fax: (203) 709-3869
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 042480 Connecticut
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 042480 Connecticut

Profile Details

NPI number 1790711059
LBN Legal business name Bogursky, Sondra Iacullo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2006
Last updated Oct 19th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790711059 NPPES
Connecticut Other 965608 USA
Connecticut Other PENDING USA
Connecticut Other 3689809/7698594 USA
Connecticut Other 24-70412 USA
Connecticut MEDICAID 001424803 USA
Connecticut Other 010042480CT01 USA
Connecticut Other 246269 USA

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