Provider Demographics
NPI:1982041869
Name:BRIGHT WATER MEDICAL PROCEDURE SUITE, PLLC
Entity Type:Organization
Organization Name:BRIGHT WATER MEDICAL PROCEDURE SUITE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-376-0055
Mailing Address - Street 1:404 POTTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1830
Mailing Address - Country:US
Mailing Address - Phone:631-376-0055
Mailing Address - Fax:631-376-0099
Practice Address - Street 1:404 POTTER BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1830
Practice Address - Country:US
Practice Address - Phone:631-376-0055
Practice Address - Fax:631-376-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical