Provider Demographics
NPI:1083276604
Name:KUSMIDER, BROOKE KATRINA
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:KATRINA
Last Name:KUSMIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RUES LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3854
Mailing Address - Country:US
Mailing Address - Phone:732-754-4071
Mailing Address - Fax:
Practice Address - Street 1:13 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3854
Practice Address - Country:US
Practice Address - Phone:732-754-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer