Healthcare Provider Details

I. General information

NPI: 1366373599
Provider Name (Legal Business Name): HELEN C IMO-BALOGUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HELEN CHIZOBA IMO-BALOGUN

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 ARSDALE TER
UNION NJ
07083-4789
US

IV. Provider business mailing address

1425 ARSDALE TER
UNION NJ
07083-4789
US

V. Phone/Fax

Practice location:
  • Phone: 908-656-1923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number26NR17740800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: