Innoba ABA, Inc

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

INNOBA ABA, INC

Practice address

5402 217TH St
Bayside Hills, NY 11364-1429

Phone

(718) 819-8828

NPI assigned

Jan 25, 2023

Last updated

Jan 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mikyeong Kim, ED.DNPI 1780946442

Title

Director

Phone

(718) 819-8828

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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.

• Mikyeong Kim

  • Specialist
  • Bayside Hills, NY
  • NPI 1780946442
  NPD Authorized official
• Natalie Ventura

  • Case Manager/Care Coordinator
  • Bayside Hills, NY
  • NPI 1053188821
  NPD

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1679289409",
    "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": "5402 217TH ST",
            "city": "BAYSIDE HILLS",
            "state": "NY",
            "postal_code": "113641429",
            "telephone_number": "718-819-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOBA ABA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MIKYEONG",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-819-8828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Eckersall
• Dawn Ann Erb
• Darlene Giunta-Ernst
• Kaycie Hernandez
• Eddie Hom
• Innoba, LLC
• Molly Joyce, M.S.ED.
• Mikyeong Kim
• Jung Ho Lee
• Annabella Li

• Early Intervention Provider Agency in Bayside Hills, NY
• Providers in Bayside Hills, NY by specialty
• Early Intervention Provider Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.