Active NPI
Samin Ali
- Mental Health Counselor
- Deer Park, NY
National Provider Identifier
1114623352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P127100
- Practice address
- 22 W 21St St
Deer Park, NY 11729-3918 - Phone
- (631) 559-1219
- NPI assigned
- Jan 31, 2023
- Last updated
- Jul 14, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P127100 | NY | Primary |
Addresses
Primary practice location
22 W 21St St
Deer Park, NY 11729-3918
Mailing address
22 W 21St St
Deer Park, NY 11729-3918
Phone (631) 559-1219
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 |
|---|---|---|---|
| P127100 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1114623352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 W 21ST ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117293918",
"telephone_number": "631-559-1219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 W 21ST ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117293918",
"telephone_number": "631-559-1219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALI",
"first_name": "SAMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-31",
"last_updated": "2025-07-14",
"certification_date": "2025-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P127100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.