Subject Numbers Regarding Health Provider Authorizations

Authorization No. 123637-1W

February 21, 2018

Please be advised that Dr. Ernesto M. Lopez has resigned his authorization to treat injured workers in the New York State workers’ compensation system effective February 15, 2018. Dr. Lopez’s last known practice addresses are:

94-03 Roosevelt Avenue
Jackson Heights, New York 11372

and

75 Franklin Avenue
Franklin Square, New York 11010

Dr. Lopez is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Lopez for services rendered prior to February 15, 2018 are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Lopez for services rendered prior to February 15, 2018 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.