Provider Demographics
NPI:1164859500
Name:MOG INTERNATIONAL LLC
Entity type:Organization
Organization Name:MOG INTERNATIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-278-4805
Mailing Address - Street 1:649 SOUTH AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3541
Mailing Address - Country:US
Mailing Address - Phone:484-278-4805
Mailing Address - Fax:484-278-4806
Practice Address - Street 1:649 SOUTH AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3541
Practice Address - Country:US
Practice Address - Phone:484-278-4805
Practice Address - Fax:484-278-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05020501163W00000X, 164W00000X, 225100000X, 251F00000X, 225X00000X, 251J00000X, 235Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty