Subject Numbers Regarding Health Provider Authorizations

Authorization No. 223034-0W

August 9, 2016

Please be advised that Dr. Nancy Catherine Blake has resigned her authorization to treat injured workers in the New York State workers’ compensation system effective August 8, 2016. Dr. Blake’s last known practice address is 500 Old Liverpool Road, Suite B, Liverpool, New York 13088.

Dr. Blake is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Blake for services rendered prior to August 8, 2016, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Blake for services rendered prior to August 8, 2016, should not be denied due to her resignation.

Any questions regarding the authorized lists should be referred to the Medical Director’s Office at 1 (800) 781-2362.