Provider Demographics
NPI:1477536183
Name:PUSKO, GEORGE (PA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:PUSKO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-826-4453
Mailing Address - Fax:860-826-6219
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-826-4453
Practice Address - Fax:860-826-6219
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000284363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000284OtherCONNECTICARE
CT290000284CT01OtherBCBS & BCFP
CT0V7366OtherHEALTH NET
CT970000539Medicare ID - Type Unspecified
CT000284OtherCONNECTICARE