Subject Numbers Regarding Health Provider Authorizations
December 7, 2007
SYEDA ZAFAR, M.D. (Authorization No. 158264-2W)
Please be advised that, by notice of the New York State Department of Health, State Board for Professional Medical Conduct, effective October 16, 2007, Dr. Syeda Zafar permanently surrendered her license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Zafar from the list of authorized physicians, effective November 14, 2007. Dr. Zafar's current address is 64 Northington Drive, East Amherst, New York 14051-1717.
Dr. Zafar is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Zafar for treatment or examinations rendered prior to October 16, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Zafar regarding treatment or examinations she rendered prior to October 16, 2007, should not be denied due to the surrender of her license or her removal from the list of authorized physicians.
LIBICO MARIO DiBLASIO, M.D. (Authorization No. 132740-2B)
Please be advised that, by Determination and Order (BPMC No. 07-128), effective November 13, 2007, the Administrative Review Board of the New York State Department of Health, State Board for Professional Medical Conduct, revoked Dr. Libico Mario DiBlasio's license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. DeBlasio from the list of authorized physicians, effective November 15, 2007. Dr. DeBlasio's current address is 385 McLean Avenue, Suite 12-G, Yonkers, New York 10705.
Dr. DeBlasio is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. DeBlasio for treatment or examinations rendered prior to November 13, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. DeBlasio regarding treatment or examinations he rendered prior to November 13, 2007, should not be denied due to the revocation of his license or his removal from the list of authorized physicians. In addition, testimony and/or depositions concerning independent medical examinations conducted through November 12, 2007, may be provided.
MARK FREILICH, M.D. (Authorization No. 125063-8W)
Please be advised that, by Consent Order (BPMC No. 07-224) of the New York State Department of Health, State Board for Professional Medical Conduct, effective October 22, 2007, Dr. Mark Freilich was placed on probation for 3 years because of a New Jersey discipline, which resulted, among other penalties, in a 6–month suspension of his medical license in that state.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Freilich from the list of authorized physicians, effective November 12, 2007. Dr. Freilich's current address is 389 Beechmont Drive, New Rochelle, New York 10804.
Dr. Freilich is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Freilich for treatment or examinations rendered prior to November 12, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Freilich regarding treatment or examinations he rendered prior to November 12, 2007, should not be denied due to his removal from the list of authorized physicians.
KRISTAPPA SANGAVARAM, M.D. (Authorization No. 133746-8W)
Please be advised that, by Consent Order (BPMC No. 07-225) of the New York State Department of Health, State Board for Professional Medical Conduct, effective October 22, 2007, Dr. Kristappa Sangavaram was placed on probation for 2 years because of a New Jersey discipline, which resulted, among other penalties, in a 6–month suspension of his medical license in that state.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Sangavaram from the list of authorized physicians, effective November 12, 2007. Dr. Sangavaram's current address is 6 Berkshire Place, Englewood Cliffs, New Jersey 07632.
Dr. Sangavaram is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Sangavaram for treatment or examinations rendered prior to November 12, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Sangavaram regarding treatment or examinations he rendered prior to November 12, 2007, should not be denied due to his removal from the list of authorized physicians.
MARK S. SHAFFER, M.D. (Authorization No. 136330-8W)
Please be advised that, by Consent Order (BPMC No. 07-219), the New York State Department of Health, State Board for Professional Medical Conduct, effective October 15, 2007, suspended Dr. Mark S. Shaffer's license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine, for 3 months.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Shaffer from the list of authorized physicians, effective November 12, 2007. Dr. Shaffer's current address is 108 Fairview Drive, Searingtown, New York 11507.
Dr. Shaffer is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Shaffer for treatment or examinations rendered prior to October 15, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Shaffer regarding treatment or examinations he rendered prior to October 15, 2007, should not be denied due to the suspension of his license or his removal from the list of authorized physicians.
MICHAEL KAMALIAN, M.D. (Authorization No. 107040-8B)
Please be advised that, by Determination and Order (BPMC No. 07-123), effective November 12, 2007, the Administrative Review Board of the New York State Department of Health, State Board for Professional Medical Conduct, sustained the Hearing Committee's determination of professional misconduct, dated June 13, 2007, but overturned the penalty and imposed a 1 year suspension of Dr. Michael Kamalian's license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine, followed by 3 years of probation with a practice limitation.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Kamalian from the list of authorized physicians, effective November 21, 2007. Dr. Kamalian's current address is 1995 Route 17M, Goshen, New York 10924.
Dr. Kamalian is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Kamalian for treatment or examinations rendered prior to November 12, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Kamalian regarding treatment or examinations he rendered prior to November 12, 2007, should not be denied due to the suspension of his license or his removal from the list of authorized physicians. In addition, testimony and/or depositions concerning independent medical examinations conducted through November 11, 2007, may be provided.
VLADIMIR KIRKOROV, M.D. (Authorization No. 203548-3W)
Please be advised that, by Determination and Order (BPMC No. 07-246) of a Hearing Committee of the New York State Department of Health, State Board for Professional Medical Conduct, effective November 15, 2007, Dr. Vladimir Kirkorov's license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine, was revoked.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Kirkorov from the list of authorized physicians, effective November 28, 2007. Dr. Kirkorov's current address is DIN # 06R3799, Oneida Correctional Facility, Inmate Mail, 6100 School Road, Rome, New York 13442.
Dr. Kirkorov is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Kirkorov for treatment or examinations rendered prior to November 15, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Kirkorov regarding treatment or examinations he rendered prior to November 15, 2007, should not be denied due to the revocation of his license or his removal from the list of authorized physicians.
PRASAD CHALASANI, M.D. (Authorization No. 111694-6W)
Please be advised that, by Determination and Order (BPMC No. 07-233) of a Hearing Committee of the New York State Department of Health, State Board for Professional Medical Conduct, effective October 31, 2007, Dr. Prasad Chalasani's license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine, was suspended for 1 year.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Chalasani from the list of authorized physicians, effective November 28, 2007. Dr. Chalasani's current address is 299 Oakley Court, Mill Neck, New York 11765.
Dr. Chalasani is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Chalasani for treatment or examinations rendered prior to October 31, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Chalasani regarding treatment or examinations he rendered prior to October 31, 2007, should not be denied due to the suspension of his license or his removal from the list of authorized physicians.
ARTHUR M. MERCADO, M.D. (Authorization No. 210640-9W)
Please be advised that, by Consent Order (BPMC No. 07-240), Dr. Arthur Mercado's application by Consent Agreement and Order was adopted by the New York State Department of Health, State Board for Professional Medical Conduct, effective November 9, 2007, and his license to practice medicine in the State of New York, or in any other jurisdiction where that practice is predicated on a valid New York State license to practice medicine, was suspended for 9 months.
Pursuant to Workers' Compensation Law Section 13-d(5), the Chair of the New York State Workers' Compensation Board has exercised his authority to remove Dr. Mercado from the list of authorized physicians, effective November 28, 2007. Dr. Mercado's current address is 12 Jonathan Court, Whitesboro, New York 13492.
Dr. Mercado is prohibited from rendering medical or other treatment and care to individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Mercado for treatment or examinations rendered prior to November 9, 2007, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Mercado regarding treatment or examinations he rendered prior to November 9, 2007, should not be denied due to the suspension of his license or his removal from the list of authorized physicians.
Any questions regarding these matters should be referred to the Office of General Counsel at (518) 486-9564.
Zachary S. Weiss
Chair