Provider Demographics
NPI:1497455695
Name:BISSO, CHARLY ANNE
Entity Type:Individual
Prefix:
First Name:CHARLY
Middle Name:ANNE
Last Name:BISSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VCARE URGENT AND PRIMARY CARE
Mailing Address - Street 2:485 GEORGES RD
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810
Mailing Address - Country:US
Mailing Address - Phone:877-623-5879
Mailing Address - Fax:
Practice Address - Street 1:VCARE URGENT AND PRIMARY CARE
Practice Address - Street 2:485 GEORGES RD
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810
Practice Address - Country:US
Practice Address - Phone:877-623-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00770400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant