Active NPI
Charisse Katherine Siracusa, PT,DPT
- Physical Therapist
- Lake Como, NJ
National Provider Identifier
1851956403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01855600
- Practice address
- 1719 Main St
Lake Como, NJ 07719-3097 - Phone
- (732) 894-9200
- NPI assigned
- May 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA01855600 | NJ | Primary |
Addresses
Primary practice location
1719 Main St
Lake Como, NJ 07719-3097
Mailing address
1719 Main St
Lake Como, NJ 07719-3097
Phone (732) 894-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40QA01855600 | Other | NJ | NJ LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01855600 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1851956403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1719 MAIN ST",
"city": "LAKE COMO",
"state": "NJ",
"postal_code": "077193097",
"telephone_number": "732-894-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1719 MAIN ST",
"city": "LAKE COMO",
"state": "NJ",
"postal_code": "077193097",
"telephone_number": "732-894-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIRACUSA",
"first_name": "CHARISSE",
"middle_name": "KATHERINE",
"credential": "PT,DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01855600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ LICENSE",
"identifier": "40QA01855600",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Como, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.