It happened around 12:30 p.m. in a building on Grand Concourse, where units responded to a report of a trauma.
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Arriving firefighters found the child, who lives on the first floor and is said to have autism, unconscious on top of the elevator, which was located in the basement of the building.
He was rushed to Harlem Hospital in critical condition. Police said the child suffered a fractured skull, but doctors believe he is expected to survive.
The boy's grandfather, Segundo Campoverde, fought back tears Thursday night. He said the 7-year-old needs surgery and is not in good shape.
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Police said the boy somehow got out of the apartment, where his grandfather and a home attendant were at the time.
Campoverde said his grandson's home aide went to the bathroom, and in the blink of an eye, the child opened the door of their first-floor apartment and took off running.
It is unclear how he got out, as there are four locks installed high up on the door because he had done this before.
"He's like very hyperactive and he opened the door," neighbor Monica Villalta said.
They had feared he would run into the street, but they never imagined he would run up to the top floor of the building, the sixth floor, and somehow manage to get inside the elevator room.
That's where the child apparently fell through an opening between the wall and the grate.
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It is unclear what floor the elevator was on when he fell, but there is speculation that the elevator wasn't all the way down in the basement.
"I was shocked," building resident Dudley Blake said. "I was thinking, how did get in there...I've been here for about couple years before and this never happened. I don't know what's going on."
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Someone in the elevator then heard the child. Firefighters removed him through the first-floor lobby access doors.
"They are very nice people, I always talk to the lady," building resident Mabel Rodriguez said. "(The child is) very quiet and very intelligent, very intelligent. He's always with his mommy and grandma, he loves his grandma."
There are cameras throughout the building and police said it wasn't long between the time the kid got out of the apartment and when his grandfather and the aide went looking for him.
His grandfather said the child is so fast. They went looking for him right away in the hallway and upstairs, but couldn't find him.
The investigation is active and ongoing.
According to the Department of Buildings website, the building in question has had 42 violations with the latest one in 2015.
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