Provider Demographics
NPI:1215974167
Name:ORUGANTI, BALAJI (PHD)
Entity type:Individual
Prefix:DR
First Name:BALAJI
Middle Name:
Last Name:ORUGANTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JASON CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2228
Mailing Address - Country:US
Mailing Address - Phone:718-757-6488
Mailing Address - Fax:
Practice Address - Street 1:2214 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4250
Practice Address - Country:US
Practice Address - Phone:718-947-3264
Practice Address - Fax:718-947-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011677235Z00000X
NJ41YS00672000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist