Provider Demographics
NPI:1801967666
Name:DECAMBRE, MARVALYN ELIZABETH (MD MPH, FAAP)
Entity type:Individual
Prefix:DR
First Name:MARVALYN
Middle Name:ELIZABETH
Last Name:DECAMBRE
Suffix:
Gender:F
Credentials:MD MPH, FAAP
Other - Prefix:
Other - First Name:PEDIATRIC ADOLESCENT
Other - Middle Name:CONTINENCE UROLOGY
Other - Last Name:MARVALYN DECAMBRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MPH FAAP
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:206-291-4269
Mailing Address - Fax:
Practice Address - Street 1:228 S ORANGE AVE FL 1
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2202
Practice Address - Country:US
Practice Address - Phone:206-291-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1294852088P0231X
MO2013009218208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology