Provider Demographics
NPI:1801353453
Name:BALOUCH, HOGAI
Entity type:Individual
Prefix:
First Name:HOGAI
Middle Name:
Last Name:BALOUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINSTON DR APT 2605
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3229
Mailing Address - Country:US
Mailing Address - Phone:845-248-1968
Mailing Address - Fax:
Practice Address - Street 1:114 BUSHWICK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1603
Practice Address - Country:US
Practice Address - Phone:845-248-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant