Subject Numbers Regarding Health Provider Authorizations

Authorization No. 206297-4B

July 18, 2013

Please be advised that Dr. William Belfar has resigned his authorizations to treat injured workers and to perform independent medical examinations in the New York State workers' compensation system effective July 3, 2013. Dr. Belfar's last known practice address is 37 East 28th Street, New York, NY 10016.

Dr. Belfar is prohibited from rendering treatment and care to injured workers and from performing independent medical examinations. Reports submitted by Dr. Belfar for services rendered prior to July 3, 2013, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Belfar for services rendered prior to July 3, 2013, should not be denied due to the resignation of his authorizations.

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