Provider Demographics
NPI:1336359850
Name:B&A PHARMACY CORP
Entity Type:Organization
Organization Name:B&A PHARMACY CORP
Other - Org Name:ENEXIA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NATENZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-734-4662
Mailing Address - Street 1:826 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2446
Mailing Address - Country:US
Mailing Address - Phone:718-720-3710
Mailing Address - Fax:
Practice Address - Street 1:252 PORT RICHMOND AVE STE B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1740
Practice Address - Country:US
Practice Address - Phone:718-556-0942
Practice Address - Fax:718-509-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602546Medicaid
NY5186600001Medicare NSC