MEDICARE: BRACHA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	62007X	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942210026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRACHA INC

Provider Business Mailing Address
First Line	:	1048 GROVE ST
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202
Country	:	US
Telephone Number	:	908-354-0002
Fax Number	:	908-354-0033

Provider Business Practice Location Address
First Line	:	1048 GROVE ST
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202
Country	:	US
Telephone Number	:	908-354-0002
Fax Number	:	908-354-0033

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ZEV FISHMAN
Credential	:
Telephone Number	:	908-354-0002

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/09/2009

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Directions to “BRACHA INC ” Practice Location

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