Individual
MR. ADEWALE MARK BALOGUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
49 GRASSLANDS CIR, MOUNT SINAI, NY 11766-1856
(631) 897-8498
(631) 666-1601
Mailing address
PO BOX 5485, BAY SHORE, NY 11706-0341
(631) 897-8498
(631) 666-1601
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
642609-1
NY
164W00000X
Licensed Practical Nurse
2583711
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02151077
—
NY
Enumeration date
11/20/2006
Last updated
09/29/2021
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