Basic Information
| Provider Information | |||||||||
| NPI: | 1144336538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISSIOS | ||||||||
| FirstName: | SYMEON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 MONTAUK HWY STE 6 | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
| FaxNumber: | 3306656748 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 MONTAUK HWY STE 6 | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
| FaxNumber: | 3306656748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35124092 | OH | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD.206973 | LA | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2370618 | 05 | LA | MEDICAID | 362659YH54 | 01 | LA | MEDICARE - PTAN | OTHER |