Subject Numbers Regarding Health Provider Authorizations

September 18, 2008

Authorization No. 095347–1W

Please be advised that, by Modification Order (BPMC No. 01–294), as adopted by the New York State Department of Health, State Board for Professional Medical Conduct, effective July 18, 2008, Carlos L. Henriquez, III, M.D. has agreed to never activate his registration or reapply for a medical license to practice medicine in the State of New York.

Effective July 18, 2008, Dr. Henriquez is precluded from treating individuals who have suffered work–related injuries or illnesses. Medical reports submitted by Dr. Henriquez for treatment or examinations rendered prior to July 18, 2008, are valid, but are invalid for any treatment or examinations rendered on or after that date. Requests to cross–examine Dr. Henriquez regarding treatment or examinations he rendered prior to July 18, 2008, should not be denied due to the inactive status of his license. Dr. Henriquez's last known address is 110 Creek Locks Road, Rosendale, New York 12472.

Any questions regarding this matter should be referred to the Office of General Counsel at (518) 486-9564.