Individual
WALTER WILLIAM BRATCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
90 BERGEN ST, NEWARK, NJ 07103-2425
(973) 972-0763
Mailing address
90 FRANKLIN STREET, CEDAR GROVE, NJ 07009
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00060300
NJ
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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