Provider Demographics
NPI:1376333930
Name:CRYSTAL HEALTH CARE PRACTITIONER IN FAMILY HEALTH P.C.
Entity type:Organization
Organization Name:CRYSTAL HEALTH CARE PRACTITIONER IN FAMILY HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMOTUNDE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADERIN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:917-653-0577
Mailing Address - Street 1:1 WINTER LN
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1626
Mailing Address - Country:US
Mailing Address - Phone:917-653-0577
Mailing Address - Fax:516-743-0323
Practice Address - Street 1:11410 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1335
Practice Address - Country:US
Practice Address - Phone:917-653-0577
Practice Address - Fax:516-743-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty