Walter William Bratchenko, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP00060300 Issued in NJ

Practice address

90 Bergen St
Newark, NJ 07103-2425

Phone

(973) 972-0763

NPI assigned

May 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University Physician Associates of New Jersey Inc

  • Orthopaedic Surgery Physician
  • Newark, NJ
  • NPI 1164432761
  Medicare reassignment
• University Physician Associates of New Jersey Inc

  • Internal Medicine Physician
  • Newark, NJ
  • NPI 1760492367
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659581031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 FRANKLIN STREET",
            "city": "CEDAR GROVE",
            "state": "NJ",
            "postal_code": "07009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032425",
            "telephone_number": "973-972-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRATCHENKO",
        "first_name": "WALTER",
        "middle_name": "WILLIAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00060300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Branford Dental Group PC
• Branford Medical Group, PC
• Branford Psychiatric Associates PC
• Lauren Brannan, MD
• Anureet Brar, MBBS
• Nikkia Bratcher
• Dario Bravo
• Ociel Bravo, L.P.C.
• Gail Braxton, LCSW
• Daiva Brazaitis, MD

• Surgical Physician Assistant in Newark, NJ
• Providers in Newark, NJ by specialty
• Surgical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.