Subject Numbers Regarding Health Provider Authorizations

February 23, 2009

Authorization No. 119604-7W

Please be advised that, by Modification Order (BPMC No. 01-291), as adopted by the New York State Department of Health, State Board for Professional Medical Conduct, effective January 5, 2009, Juan Carlos Pellin, M.D., has agreed to never activate his registration or reapply for a medical license to practice medicine in the State of New York.

Effective January 5, 2009, Dr. Pellin is precluded from treating individuals who have suffered work-related injuries or illnesses. Medical reports submitted by Dr. Pellin for treatment or examinations rendered prior to January 5, 2009, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross-examine Dr. Pellin regarding treatment or examinations he rendered prior to January 5, 2009, should not be denied due to the inactive status of his license. Dr. Pellin's last known address is 2903 Point East Drive, Apt. K211, Aventura, Florida 33160-5411.

Any questions regarding this matter should be referred to the Office of General Counsel at (518) 486-9564.