Healthcare Provider Details

I. General information

NPI: 1063342335
Provider Name (Legal Business Name): ADAM ASARALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOUTH AVE
STATEN ISLAND NY
10303-1512
US

IV. Provider business mailing address

863 E 57TH ST
BROOKLYN NY
11234-1907
US

V. Phone/Fax

Practice location:
  • Phone: 347-881-3407
  • Fax:
Mailing address:
  • Phone: 631-633-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: