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General NPI Number Information
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NPI Number | 1831798362
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Entity Type | Individual
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Provider Name | BRANDON H KUSAKO PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 100 GRAND ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-2016
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Country | US
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Telephone | 860-223-0800
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Fax | 860-223-0444
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-5507
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Fax | 860-972-7040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5069
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License Number State | CT
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