Subject Numbers Regarding Health Provider Authorizations

Authorization No. 196473-3W

December 8, 2023

Please be advised that Dr. Erie T. Agustin has resigned his authorization to treat injured workers in the New York State workers' compensation system effective November 27, 2023. Dr. Agustin's last known practice addresses are:

Erie T. Agustin, M.D. P.C.
5801 Woodside Ave, Suite 2
Woodside, New York 11377

and

Queens Wound & Medical Care P.C.
6535 Queens Boulevard, Suite 100
Woodside, New York 11377

Dr. Agustin is prohibited from rendering treatment and care to injured workers, and from conducting reviews of records regarding variance requests pursuant to 12 New York Codes, Rules and Regulations § 324.3(b)(2)(ii)(a). Reports submitted by Dr. Agustin for services rendered prior to November 27, 2023, are valid but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Agustin for services rendered prior to November 27, 2023, 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.