Subject Numbers Regarding Health Provider Authorizations

Authorization No. 152199-6W

December 28, 2021

Please be advised that Dr. Mark Roy Siegelheim has resigned his authorization to treat injured workers in the New York State workers' compensation system effective December 24, 2021. Dr. Siegelheim's last known practice addresses are:

332 East Main Street
Bay Shore, New York 11706
and
200 Howells Road
Bay Shore, New York 11706

Dr. Siegelheim is prohibited from rendering treatment and care to injured workers, and from conducting reviews of records regarding variance requests pursuant to 12 NYCRR § 324.3(b)(2)(ii)(a). Reports submitted by Dr. Siegelheim for services rendered prior to December 24, 2021, are valid but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Siegelheim for services rendered prior to December 24, 2021, should not be denied due to his resignation.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.