Individual provider Active NPI

Samuel Weiser

  • Social Worker
  • Monroe, NY
National Provider Identifier
1619421476
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
090986 Issued in NY
Practice address
48 Bakertown Rd
Monroe, NY 10950-8428
Phone
(845) 263-4130
NPI assigned
Aug 10, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 090986 NY Primary

Addresses

Primary practice location

48 Bakertown Rd
Monroe, NY 10950-8428

Mailing address

48 Bakertown Rd
Monroe, NY 10950-8428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220224002335 NY Practitioner - Clinical Social Worker 3072907682 Reassigns benefits to 2 organizations
Practice locations: Monsey, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
090986NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Shiny Triangle LCSW PC CurrentSince Feb 9, 2022 Accepting new patients
Community Assistance Resources & Extended Services Inc CurrentSince Jul 8, 2024 Accepting new patients

Locations

465 Grand St
New York, NY 10002
Phone (212) 420-1970

254 Old Nyack Tpke
Spring Valley, NY 10977
Phone (800) 747-4226

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.

NPI Registry JSON

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1619421476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 BAKERTOWN RD",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109508428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 BAKERTOWN RD",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109508428",
            "telephone_number": "845-263-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISER",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "090986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

Verify at the official NPI Registry.