Provider Demographics
NPI:1962728949
Name:BALOGUN, ONYINYE (MD)
Entity type:Individual
Prefix:DR
First Name:ONYINYE
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ONYINYE
Other - Middle Name:
Other - Last Name:OFFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 169
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-6050
Mailing Address - Fax:212-746-8749
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:SUITE N-046
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-3600
Practice Address - Fax:212-746-8749
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2813812085R0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program