Crystal Health Care Nurse Practitioner in Family Health P.C.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

CRYSTAL HEALTH CARE NURSE PRACTITIONER IN FAMILY HEALTH P.C.

Practice address

11410 Merrick Blvd
Jamaica, NY 11434-1335

Phone

(917) 653-0577

Fax

(516) 743-0323

NPI assigned

May 7, 2025

Organization subpart

No

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

Authorized official

Name

Omotunde D Aderin, NURSE PRACTITIONERNPI 1881248938

Title

Ceo

Phone

(917) 653-0577

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Omotunde D Aderin, NP

  • Family Nurse Practitioner
  • Amityville, NY
  • NPI 1881248938

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763683200000",
    "number": "1376333930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WINTER LN",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117011626",
            "telephone_number": "917-653-0577",
            "fax_number": "516-743-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11410 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341335",
            "telephone_number": "917-653-0577",
            "fax_number": "516-743-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL HEALTH CARE NURSE PRACTITIONER IN FAMILY HEALTH P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A",
        "authorized_official_last_name": "ADERIN",
        "authorized_official_first_name": "OMOTUNDE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-653-0577",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.