Subject Numbers Regarding Health Provider Authorizations

Authorization No. 234062-8W

June 13, 2019

Please be advised that Dr. Chad Itzkovich has resigned his authorization to treat injured workers in the New York State workers’ compensation system effective June 12, 2019. Dr. Itzkovich’s last known practice address is:

116-16 Queens Boulevard, Suite 235
Forest Hills, New York 11374

Dr. Itzkovich 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. Itzkovich for services rendered prior to June 12, 2019, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Itzkovich for services rendered prior to June 12, 2019, 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.