Subject Numbers Regarding Health Provider Authorizations

Authorization No. PT020160-8W

April 21, 2023

Please be advised that physical therapist (P.T.) Eleazar V. Incabo has resigned his authorization to treat injured workers in the New York State workers' compensation system effective April 19, 2023. P.T. Incabo's last known practice addresses are:

Physical Medicine and Rehab
365 Route 304, Suite 100
Bardonia, New York 10954

Physical Medicine and Rehab
6132 Riverdale Avenue
Riverdale, New York 10471

and

500 Grand Avenue, Suite 100
Englewood, New Jersey 07631

P.T. Incabo is prohibited from rendering treatment and care to injured workers, and from conducting reviews of records regarding variance requests pursuant to 12 NYCRR § 324.3(b)(2)(ii)(a). Reports submitted by P.T. Incabo for services rendered prior to April 19, 2023, are valid but are invalid for any services rendered on or after that date. Requests to cross-examine P.T. Incabo for services rendered prior to April 19, 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.