Individual provider Active NPI

Olga Tkachenko

  • Certified Registered Nurse Anesthetist
  • Wayne, NJ
National Provider Identifier
1972162089
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NJ01293100 Issued in NJ
Practice address
224 Hamburg Tpke
Wayne, NJ 07470-2168
Phone
(973) 942-6900
NPI assigned
Jun 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 622678 NY
Certified Registered Nurse Anesthetist 367500000X 26NJ01293100 NJ Primary

Addresses

Primary practice location

224 Hamburg Tpke
Wayne, NJ 07470-2168

Mailing address

3545 79TH St Apt 5E
Jackson Heights, NY 11372-4836
Phone (347) 350-4934

Other practice location 1

560 W 168th St
New York, NY 10032-3917
Phone (212) 305-5756

Other practice location 2

703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220601000675 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 6507244761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Valley Anesthesiology PAGroup PAC ID 0749194868, 85 clinicians

Practice addresses (Care Compare)

350 Engle St
Englewood, NJ 07631-1808
Phone (201) 871-6073

Hospital & facility affiliations

  • Englewood Hospital and Medical Center Hospital, Englewood, NJ, CCN 310045
  • St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26NJ01293100NJMDCertified Registered Nurse Anesthetist
622678NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia of New Jersey LLC CurrentSince Sep 1, 2024 Accepting new patients
Northern Valley Anesthesiology, P.a. CurrentSince Jul 1, 2022 Accepting new patients

Locations

350 Engle St
Englewood, NJ 07631
Phone (201) 871-6073

300 2nd Ave
Long Branch, NJ 07740
Phone (732) 222-5200

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1972162089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 79TH ST APT 5E",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113724836",
            "telephone_number": "347-350-4934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 HAMBURG TPKE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702168",
            "telephone_number": "973-942-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "560 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323917",
            "country_code": "US",
            "telephone_number": "212-305-5756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 Main St",
            "address_purpose": "LOCATION",
            "city": "Paterson",
            "state": "NJ",
            "postal_code": "075032621",
            "country_code": "US",
            "telephone_number": "973-754-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TKACHENKO",
        "first_name": "OLGA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "622678",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ01293100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.