Elemy Iop LLC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

ELEMY IOP LLC

Practice address

6303 Blue Lagoon Dr Ste 400
Miami, FL 33126-6040

Phone

(833) 458-0386

NPI assigned

Jul 8, 2022

Organization subpart

Yes

Parent organization

FL MC SPROUT 1 LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yury Yakubchyk

Title

Ceo

Phone

(833) 458-0386

Specialties & licenses 1

Addresses

Part of

FL MC Sprout 1 LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1083347868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6303 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331266040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6303 BLUE LAGOON DR STE 400",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331266040",
            "telephone_number": "833-458-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMY IOP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FL MC SPROUT 1 LLC",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "YAKUBCHYK",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "833-458-0386"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.