Healthcare Provider Details

I. General information

NPI: 1851379192
Provider Name (Legal Business Name): CHARINA A CARISSIMI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRESIDENTIAL PLZ 3RD FLOOR
SYRACUSE NY
13202-2240
US

IV. Provider business mailing address

90 PRESIDENTIAL PLZ 3RD FLOOR
SYRACUSE NY
13202-2240
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4458
  • Fax: 315-464-6388
Mailing address:
  • Phone: 315-464-4458
  • Fax: 315-464-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001142
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: