Provider Demographics
NPI:1578117628
Name:NU-MD UROLOGY PC
Entity Type:Organization
Organization Name:NU-MD UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER, DIRECTOR OF SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVALYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DECAMBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH MBA
Authorized Official - Phone:973-348-9022
Mailing Address - Street 1:382 WOODLAND PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2447
Mailing Address - Country:US
Mailing Address - Phone:973-348-9022
Mailing Address - Fax:973-819-2956
Practice Address - Street 1:201 S LIVINGSTON AVE STE 2F
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4040
Practice Address - Country:US
Practice Address - Phone:973-348-9022
Practice Address - Fax:855-819-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty