Adewale Mark Balogun, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

642609-1 Issued in NY

Practice address

49 Grasslands Cir
Mount Sinai, NY 11766-1856

Phone

(631) 897-8498

Fax

(631) 666-1601

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1457425613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5485",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117060341",
            "telephone_number": "631-897-8498",
            "fax_number": "631-666-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 GRASSLANDS CIR",
            "city": "MOUNT SINAI",
            "state": "NY",
            "postal_code": "117661856",
            "telephone_number": "631-897-8498",
            "fax_number": "631-666-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOGUN",
        "first_name": "ADEWALE",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "2583711",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NY",
            "license": "642609-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02151077",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elaine Mary Argueta
• Rise Armel, PHYSICIAN ASSISTANT
• Colleen Auletta
• Jennifer Avallone
• Denise Axelband
• Evan Barbakoff, DMD
• Nureen Barkat
• Faith N. Barrentine, PH.D.
• Ashley Becker
• Gregory Bellias

• General Practice Registered Nurse in Mount Sinai, NY
• Providers in Mount Sinai, NY by specialty
• General Practice Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.