Healthcare Provider Details

I. General information

NPI: 1528971025
Provider Name (Legal Business Name): MR. TIMOTHY SANGJOON PAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-08 ROUTE 208 STE 16
FAIR LAWN NJ
07410-2609
US

IV. Provider business mailing address

22-08 ROUTE 208 STE 16
FAIR LAWN NJ
07410-2609
US

V. Phone/Fax

Practice location:
  • Phone: 201-956-6363
  • Fax:
Mailing address:
  • Phone: 201-956-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC01006800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: