Provider Demographics
NPI:1912006537
Name:SYAMOQ ELDERCARE, INC
Entity Type:Organization
Organization Name:SYAMOQ ELDERCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOQEETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-569-6780
Mailing Address - Street 1:PO BOX 638196
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8196
Mailing Address - Country:US
Mailing Address - Phone:513-569-6780
Mailing Address - Fax:513-789-8491
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:STE 645
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6780
Practice Address - Fax:513-789-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200903770AMedicaid
OHDP4690OtherRR MEDICARE
OH2957448Medicaid
OH9333521Medicare PIN