Individual
CHARISSE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(516) 783-4600
Mailing address
958 DOWNING RD, VALLEY STREAM, NY 11580-1509
(917) 974-4524
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00701600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02831643
—
NY
01
—
P00330253
RAILROAD
—
Enumeration date
03/22/2006
Last updated
12/16/2025
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