Healthcare Provider Details

I. General information

NPI: 1578117628
Provider Name (Legal Business Name): NU-MD UROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LIVINGSTON AVE STE 2F
LIVINGSTON NJ
07039-4040
US

IV. Provider business mailing address

382 WOODLAND PL
SOUTH ORANGE NJ
07079-2447
US

V. Phone/Fax

Practice location:
  • Phone: 973-348-9022
  • Fax: 855-819-2956
Mailing address:
  • Phone: 973-348-9022
  • Fax: 973-819-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARVALYN ELIZABETH DECAMBRE
Title or Position: CEO, FOUNDER, DIRECTOR OF SERVICES
Credential: MD MPH MBA
Phone: 973-348-9022