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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-690

Changes to the List of Health Care Providers Authorized to
Render Services to Injured Workers
Under the Workers' Compensation Law

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
Chair