Healthcare Provider Details

I. General information

NPI: 1063534238
Provider Name (Legal Business Name): MERCEDES BORDERA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MADISON AVE SUITE 803
NEW YORK NY
10017-1107
US

IV. Provider business mailing address

420 MADISON AVE SUITE 803
NEW YORK NY
10017-1107
US

V. Phone/Fax

Practice location:
  • Phone: 609-304-7200
  • Fax: 212-319-0435
Mailing address:
  • Phone: 609-304-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010298-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: