Healthcare Provider Details

I. General information

NPI: 1659630630
Provider Name (Legal Business Name): SOPHIA MORISSEAU DECAMBRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

IV. Provider business mailing address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax:
Mailing address:
  • Phone: 718-945-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number260627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: