Healthcare Provider Details

I. General information

NPI: 1407291867
Provider Name (Legal Business Name): ANDREW DONGUK NAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DONGUK NAM MD

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 LEMOINE AVE STE 203
FORT LEE NJ
07024-5636
US

IV. Provider business mailing address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

V. Phone/Fax

Practice location:
  • Phone: 201-944-8400
  • Fax: 201-944-8411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA10392300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA10392300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: