Provider Demographics
NPI:1649533472
Name:MISSIH, OMOTOKE O (MD)
Entity type:Individual
Prefix:DR
First Name:OMOTOKE
Middle Name:O
Last Name:MISSIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OMOTOKE
Other - Middle Name:O
Other - Last Name:AROWOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 ELY PARK BLVD
Mailing Address - Street 2:APT N1
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1480
Mailing Address - Country:US
Mailing Address - Phone:631-671-4497
Mailing Address - Fax:
Practice Address - Street 1:1 ELY PARK BLVD
Practice Address - Street 2:APT N1
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1480
Practice Address - Country:US
Practice Address - Phone:631-671-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2832471207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology