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General NPI Number Information
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NPI Number | 1164859500
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Entity Type | Organization
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Legal Business Name | MOG INTERNATIONAL LLC
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 649 SOUTH AVE UNIT 8
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City | SECANE
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State | PA
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Zip | 19018-3541
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Country | US
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Telephone | 484-278-4805
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Fax | 484-278-4806
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Provider Business Mailing Address
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Address Line | 649 SOUTH AVE UNIT 8
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City | SECANE
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State | PA
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Zip | 19018-3541
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Country | US
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Telephone | 484-278-4805
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Fax | 484-278-4806
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | MR. OLAYEMI OLUKANNI
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Credential |
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Telephone | 484-278-4805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 05020501
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 05020501
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 05020501
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 05020501
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 05020501
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05020501
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 05020501
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 05020501
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License Number State | PA
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