Brightwaters Internal Medicine PLLC

Primary specialty

Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X

License

152199 Issued in NY

Legal business name

BRIGHTWATERS INTERNAL MEDICINE PLLC

Practice address

200 Howells Rd
Bay Shore, NY 11706-5300

Phone

(631) 665-5074

Fax

(631) 665-1852

NPI assigned

Jun 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Siegelheim, M.D.

Title

Physician

Phone

(631) 665-5074

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255533360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOWELLS RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117065300",
            "telephone_number": "631-665-5074",
            "fax_number": "631-665-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOWELLS RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117065300",
            "telephone_number": "631-665-5074",
            "fax_number": "631-665-1852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTWATERS INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIEGELHEIM",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "631-665-5074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NY",
            "license": "152199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bay Shore, NY
• Sleep Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.