Healthcare Provider Details

I. General information

NPI: 1033542204
Provider Name (Legal Business Name): SUDOWSKI MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BOSTON POST RD
WATERFORD CT
06385-2819
US

IV. Provider business mailing address

210 BOSTON POST RD
WATERFORD CT
06385-2819
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-3180
  • Fax: 860-447-9444
Mailing address:
  • Phone: 860-442-3180
  • Fax: 860-447-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BONNIE M SUDOWSKI
Title or Position: SOLE MEMBER
Credential:
Phone: 860-442-3180