Provider Demographics
NPI:1588229926
Name:KUSIAK, ELISABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:KUSIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-999-9999
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:31 LOWER HUDSON AVE
Practice Address - Street 2:
Practice Address - City:GREEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:12183-1014
Practice Address - Country:US
Practice Address - Phone:518-272-9140
Practice Address - Fax:518-272-9145
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY033121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical