Provider Demographics
NPI:1831896430
Name:FRANCISCO, CHARISSA MAE
Entity type:Individual
Prefix:
First Name:CHARISSA MAE
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARISSA MAE
Other - Middle Name:
Other - Last Name:FRANCISCO-ATTIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1406
Mailing Address - Country:US
Mailing Address - Phone:973-618-8033
Mailing Address - Fax:
Practice Address - Street 1:29 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1406
Practice Address - Country:US
Practice Address - Phone:973-618-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033721208100000X
NJ40QA01653300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01653300OtherNJ PHYSICAL THERAPY LICENSE