Provider Demographics
NPI:1417279605
Name:BORAWALA, ANUP
Entity Type:Individual
Prefix:
First Name:ANUP
Middle Name:
Last Name:BORAWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WISNIEWSKI RD
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1587
Mailing Address - Country:US
Mailing Address - Phone:732-735-2691
Mailing Address - Fax:
Practice Address - Street 1:176 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6932
Practice Address - Country:US
Practice Address - Phone:201-947-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03137200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9065300Medicaid