Subject Numbers Regarding Health Provider Authorizations

Authorization No. 209187-4W

May 7, 2013

Please be advised that Dr. Jonathan Block has resigned his authorization to treat injured workers in the New York State workers' compensation system effective July 17, 2012. Dr. Block's last known practice address is 2 Ellinwood Drive, New Hartford, New York, 13413.

Dr. Block is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Block for services rendered prior to July 17, 2012, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Block for services rendered prior to July 17, 2012, 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.