Individual provider Active NPI

Michael C Crismali, MD

  • Family Medicine Physician
  • Forest Hills, NY
National Provider Identifier
1053339838
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1573881 Issued in NY
Practice address
11835 Queens Blvd Ste 400
Forest Hills, NY 11375-7211
Phone
(646) 722-7610
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1573881 NY Primary

Addresses

Primary practice location

11835 Queens Blvd Ste 400
Forest Hills, NY 11375-7211

Mailing address

PO Box 639295
Cincinnati, OH 45263-9295
Phone (248) 266-4200

Other practice location 1

1000 Church Ave
Flatbush Center
Brooklyn, NY 11218
Phone (718) 826-4000

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070516000322 NY Practitioner - Family Practice 4486751013 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1573881NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Young Adult Institute, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Premier Healthcare, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Premier Healthcare, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Harmony Medical Services of New York, PLLC Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
Park Avenue Medical Associates, P.C. PastSince Dec 4, 1999 Accepting new patients

Locations

21111 Northern Blvd
Bayside, NY 11361
Phone (212) 563-7474

11835 Queens Blvd
Ste 400
Forest Hills, NY 11375
Phone (646) 722-7610

460 W 34th St
Fl 9
New York, NY 10001
Phone (212) 273-6515

1802 Petracca Pl
Ste 103
Whitestone, NY 11357
Phone (646) 722-7610

Interoperability endpoints

  • Direct secure messaging: michael.crismali.1@32913.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1053339838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639295",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639295",
            "telephone_number": "248-266-4200",
            "fax_number": "855-618-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD STE 400",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757211",
            "telephone_number": "646-722-7610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Church Ave",
            "address_2": "Flatbush Center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11218",
            "country_code": "US",
            "telephone_number": "718-826-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISMALI",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "1573881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.