Subject Numbers Regarding Health Provider Authorizations

Authorization No. 115465-7W

March 24, 2022

Please be advised that Dr. Alfonso Tan has resigned his authorization to treat injured workers in the New York State workers' compensation system effective March 15, 2022. Dr. Tan's last known practice address is:

297 West Main Street
Sayville, New York 11782

Dr. Tan 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 Dr. Tan for services rendered prior to March 15, 2022, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Tan for services rendered prior to March 15, 2022, 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.