Active NPI
Michelle Kim
- Counselor
- New York, NY
National Provider Identifier
1124561899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 00221983
- Practice address
- 55 W 125TH St FL 11
New York, NY 10027-4516 - Phone
- (212) 864-4128
- Fax
- (212) 662-9193
- NPI assigned
- Nov 29, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 00221983 | NY | Primary |
Addresses
Primary practice location
55 W 125TH St FL 11
New York, NY 10027-4516
Mailing address
55 W 125TH St FL 11
New York, NY 10027-4516
Phone (212) 864-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00221983 | NY | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Village, Inc. | Past | Accepting new patients | |
| Samaritan Village Harlem Outpatient | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adult Mental Health Clinic/Center
- New York, NY
- NPI 1740650332
-
- Substance Use Disorder Rehabilitation Clinic/Center
- New York, NY
- NPI 1548347719
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480377600000",
"number": "1124561899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 W 125TH ST FL 11",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100274516",
"telephone_number": "212-864-4128",
"fax_number": "212-662-9193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 W 125TH ST FL 11",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100274516",
"telephone_number": "212-864-4128",
"fax_number": "212-662-9193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-29",
"last_updated": "2016-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NY",
"license": "00221983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.