Healthcare Provider Details

I. General information

NPI: 1912006537
Provider Name (Legal Business Name): SYAMOQ ELDERCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 OAK ST STE 645
CINCINNATI OH
45206-1613
US

IV. Provider business mailing address

PO BOX 638196
CINCINNATI OH
45263-8196
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6780
  • Fax: 513-789-8491
Mailing address:
  • Phone: 513-569-6780
  • Fax: 513-789-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SYED A MOQEETH
Title or Position: OWNER
Credential: MD
Phone: 513-569-6780