Date: May 27, 2014
Pursuant to Workers’ Compensation Law § 13-b, a provider must be licensed and registered with the New York State Education Department in order to maintain a Workers’ Compensation Board authorization(s).
The following have been removed from the list of providers authorized to treat injured workers and/or perform independent medical examinations within the New York State workers’ compensation system based on information provided by the New York State Education Department indicating that they do not currently have an active license to practice medicine in New York State.
|NAME||LAST KNOWN CITY OF PRACTICE||AUTHORIZATION NUMBER*||EFFECTIVE DATE|
|Jones, Susann||Woodside, NY||C03480-3W||March 13, 2014|
|Kaddouri, Sami||New York, NY||095828-0W||March 13, 2014|
|Kang, Richard||Out of State||232909-2W||March 13, 2014|
|Knapp, Jody L.||Out of State||C10508-2W||March 13, 2014|
|Manta, Adriana||Bronx, NY||212397-4B||March 13, 2014|
|Adegbite, Samson||Batavia, NY||175350-8W||April 4, 2014|
|Kim, Choong Kwon||Valley Stream, NY||128613-7B||April 4, 2014|
* Providers authorized to treat only, have an authorization number ending in "W" – Providers authorized to treat and perform independent medical examinations, have an authorization number ending in "B" – Providers authorized to perform independent medical examinations only, have an authorization number ending in "I"
These providers are prohibited from rendering treatment and care to injured workers and/or from performing independent medical examinations. Reports submitted for services rendered prior to the effective date are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine any of the above for services rendered prior to the effective date should not be denied due to the removal of their authorizations.
Robert E. Beloten