SONDRA IACULLO BOGURSKY (NPI# 1790711059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790711059 |
| Entity Type | Individual |
| Full Name | SONDRA IACULLO BOGURSKY |
| Credential | MD |
| Practice Address |
95 Scovill St 3rd Floor Waterbury CT 06706-1113 |
| Mailing Address |
56 Franklin St 3rd Floor Waterbury CT 06706-1221 |
| Practice Telephone | 2037093800 |
| Practice Fax Number | 2037093869 |
| Mailing Telephone | 2037098873 |
| Mailing Fax Number | 2037098689 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2014-07-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 042480 | CT | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 042480 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | WELLCARE | 246269 | 01 |
| CT | USA | 965608 | 01 |
| CT | 001424803 | 05 | |
| CT | UHC | 24-70412 | 01 |
| CT | AETNA | 3689809/7698594 | 01 |
| CT | RAILROAD MEDICARE | PENDING | 01 |
| CT | ANTHEM BCBS CT | 010042480CT01 | 01 |
| Street Address |
95 SCOVILL ST 3RD FLOOR |
| City | WATERBURY |
| State | CT |
| Zip Code | 06706-1113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477591097 | Samer Ein Alshaeba | Internal Medicine | 95 Scovill St, Waterbury, CT 06706-1113 | 2006-06-04 |
| 1831580745 | Staywell Health Care Inc | Clinic/Center | 95 Scovill St, 3rd Floor Pavillion B, Waterbury, CT 06706-1113 | 2015-02-13 |
| 1588961742 | Kathryn Anne Loughlin | Social Worker | 95 Scovill St, Pavillion B, 3rd Floor, Waterbury, CT 06706-1113 | 2011-02-23 |
| 1285892703 | Allyson Lynn Rovetto | Pediatrics | 95 Scovill St, 3rd Floor, Pavilion B, Waterbury, CT 06706-1113 | 2008-05-30 |
| 1760678965 | Jennifer Voisine Kloze | Pharmacist | 95 Scovill St, Waterbury, CT 06706-1113 | 2007-09-20 |
| 1023139391 | Mary Ann Rourke | Social Worker | 95 Scovill St, 3rd Floor, Waterbury, CT 06706-1113 | 2007-04-03 |
| 1699896902 | Christine Cunningham | Social Worker | 95 Scovill St, 3rd Floor, Waterbury, CT 06706-1113 | 2007-04-03 |
| 1245321553 | Alan Richard Malina | Internal Medicine | 95 Scovill St, Waterbury, CT 06706-1113 | 2006-09-28 |
| 1821001454 | Judith Lynne Moskal-kanz | Nurse Practitioner | 95 Scovill St, 3rd Floor, Waterbury, CT 06706-1113 | 2006-08-14 |
| 1497771208 | Richard Shea | Pediatrics | 95 Scovill St, 3rd Floor, Waterbury, CT 06706-1113 | 2006-07-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245750538 | Sameerah Ibtisam Rehmani | Internal Medicine | St Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706 | 2017-06-27 |
| 1417208448 | Sherry L Gatling | Durable Medical Equipment & Medical Supplies | 394 Mill Street, 2nd Flr N, Waterbury, CT 06706 | 2012-10-01 |
| 1144505538 | Amanda Maria Delcavo | Physician Assistant | 50 Franklin Street, Waterbury, CT 06706 | 2011-10-17 |
| 1508097031 | Lauren K Ayr-volta | Clinical Neuropsychologist | 133 Scovill Street, Suite 211, Waterbury, CT 06706 | 2009-07-31 |
| 1538206800 | John Chardavoyne | Psychiatry & Neurology | Waterbury Outpatient Clinic, 95 Scovill Street, Waterbury, CT 06706 | 2007-01-30 |
| 1922111632 | Thomas Owen Genese | Internal Medicine | 56 Franklin Street, St. Mary's Hospital - Dept of Medicine, Waterbury, CT 06706 | 2006-08-16 |
| 1013942465 | Nancy Lou Kline | Nurse Practitioner | 133 Scovill Street-waterbury Va Community Based Clinic, #203, Waterbury, CT 06706 | 2006-07-12 |
| 1013455351 | Denisse Burgos-jimenez | Physician Assistant | 56 Franklin St, Waterbury, CT 06706 | 2017-02-07 |
| 1902255086 | Kaitlyn Jennings | Physician Assistant | 56 Franklin St, Waterbury, CT 06706 | 2016-06-08 |
| 1366823783 | Yamini Sachan | Internal Medicine | 56 Franklin Street, Waterbury, CT 06706 | 2015-06-11 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245750538 | Sameerah Ibtisam Rehmani | Internal Medicine | St Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706 | 2017-06-27 |
| 1053799544 | Emily Pinto Taylor | Internal Medicine | 133 Scovill St Ste 300, Waterbury, CT 06706-1127 | 2015-05-15 |
| 1578849519 | Uday Shankar | Internal Medicine | 3801 E Main St Fl 2, Waterbury, CT 06705 | 2011-10-21 |
| 1275828261 | Bechoi Saleib | Internal Medicine | 1981 E Main St, 2nd Floor, Waterbury, CT 06705-1822 | 2011-06-17 |
| 1750525549 | Benjamin Bodnar | Internal Medicine | 95 Scovill St Fl 3, Waterbury, CT 06706-1113 | 2009-04-24 |
| 1588848766 | Tracy Lyn Rabin | Internal Medicine | 64 Robbins Street, Waterbury Hospital Campus, Main 3, Yale Primary Care Program, Waterbury, CT 06708 | 2007-12-24 |
| 1255549622 | Ashish Arora | Internal Medicine | 133 Scovill St Ste 104, Waterbury, CT 06706-1127 | 2007-05-18 |
| 1780782953 | Vidya Loganathan | Internal Medicine | 2457 E Main St Ste 1e, Waterbury, CT 06705-2684 | 2006-09-20 |
| 1083724967 | Westside Medical Group | Internal Medicine | 714 Chase Parkway, Suite 6, Waterbury, CT 06708-3939 | 2006-08-30 |
| 1922111632 | Thomas Owen Genese | Internal Medicine | 56 Franklin Street, St. Mary's Hospital - Dept of Medicine, Waterbury, CT 06706 | 2006-08-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.