Healthcare Provider Details

I. General information

NPI: 1144058512
Provider Name (Legal Business Name): CRYSTI MINCEY NP IN ADULT HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST STE 550
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

6143 186TH ST STE 550
FRESH MEADOWS NY
11365-2710
US

V. Phone/Fax

Practice location:
  • Phone: 929-671-7849
  • Fax: 574-406-7610
Mailing address:
  • Phone: 347-528-9868
  • Fax: 574-406-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRYSTI MINCEY
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 929-867-1784