Provider Demographics
NPI:1093819484
Name:MISSIG, JAMES (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:MISSIG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5 5TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7368
Mailing Address - Country:US
Mailing Address - Phone:631-277-1803
Mailing Address - Fax:631-581-0015
Practice Address - Street 1:5 5TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7368
Practice Address - Country:US
Practice Address - Phone:631-277-1803
Practice Address - Fax:631-581-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY446026-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered