Provider Demographics
NPI:1508277674
Name:BALOGUN, FIYINFOLU OLADELE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FIYINFOLU
Middle Name:OLADELE
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 66TH ST # 1217
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6800
Mailing Address - Country:US
Mailing Address - Phone:212-888-6964
Mailing Address - Fax:
Practice Address - Street 1:300 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6800
Practice Address - Country:US
Practice Address - Phone:212-888-6964
Practice Address - Fax:646-227-7284
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY282122207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine