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General NPI Number Information
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NPI Number | 1407291867
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Entity Type | Individual
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Provider Name | ANDREW DONGUK NAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1608 LEMOINE AVE STE 203
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City | FORT LEE
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State | NJ
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Zip | 07024-5636
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Country | US
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Telephone | 201-944-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 350 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA10392300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA10392300
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License Number State | NJ
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