Provider Demographics
NPI:1093757429
Name:BURACHINSKY, ANDREW E (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:BURACHINSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6318
Mailing Address - Country:US
Mailing Address - Phone:201-991-8565
Mailing Address - Fax:201-991-2408
Practice Address - Street 1:62 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6318
Practice Address - Country:US
Practice Address - Phone:201-991-8565
Practice Address - Fax:201-991-2408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03504400207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1743007Medicaid
NJC56989Medicare UPIN
NJ1743007Medicaid