MEDICARE: OMOKEMI BALOGUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1497693014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMOKEMI BALOGUN

Provider Business Mailing Address
First Line	:	175 BELGROVE DR
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 REDLAND CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3264
Country	:	US
Telephone Number	:	201-979-1336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ OMOKEMI BALOGUN ” Practice Location

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