Provider Demographics
NPI:1962872861
Name:MB INTEGRATIVE MEDICINE LLC
Entity type:Organization
Organization Name:MB INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-506-0642
Mailing Address - Street 1:6803 EMLEN ST
Mailing Address - Street 2:APT 209
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2635
Mailing Address - Country:US
Mailing Address - Phone:267-506-0642
Mailing Address - Fax:267-502-3000
Practice Address - Street 1:6782 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2110
Practice Address - Country:US
Practice Address - Phone:267-506-0642
Practice Address - Fax:267-502-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty