NPIMap

Organization Active NPI

Innoba, LLC

  • Community/Behavioral Health Agency
  • Bayside Hills, NY
National Provider Identifier
1639561350
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
000632 Issued in NY
Legal business name
INNOBA, LLC
Practice address
5143 Bell Blvd
Bayside Hills, NY 11364-1225
Phone
(718) 640-6550
NPI assigned
Mar 4, 2015
Last updated
Mar 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Authorized official

Name
Dr. Mikyeong Kim, LBANPI 1780946442
Title
Director
Phone
(718) 640-6550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 000632 NY Primary

Addresses

Primary practice location

5143 Bell Blvd
Bayside Hills, NY 11364-1225

Mailing address

5143 Bell Blvd
Bayside Hills, NY 11364-1225

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1639561350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5143 BELL BLVD",
            "city": "BAYSIDE HILLS",
            "state": "NY",
            "postal_code": "113641225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5143 BELL BLVD",
            "city": "BAYSIDE HILLS",
            "state": "NY",
            "postal_code": "113641225",
            "telephone_number": "718-640-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOBA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MIKYEONG",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-640-6550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "000632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.