Provider Demographics
NPI:1497288666
Name:BORAWALA LLC
Entity Type:Organization
Organization Name:BORAWALA LLC
Other - Org Name:MAIN STREET SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANUP
Authorized Official - Middle Name:
Authorized Official - Last Name:BORAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-735-2691
Mailing Address - Street 1:881 MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1456
Mailing Address - Country:US
Mailing Address - Phone:732-475-3311
Mailing Address - Fax:732-475-3322
Practice Address - Street 1:881 MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1456
Practice Address - Country:US
Practice Address - Phone:732-475-3311
Practice Address - Fax:732-475-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007552003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0614696Medicaid
2168654OtherPK