Subject Numbers Regarding Health Provider Authorizations

July 14, 2009

Authorization No. 206169-5W

Please be advised that Walter Andrew Medina Sr., D.O., surrendered his license to practice medicine in the State of New York, effective June 30, 2009. No current business address is available for Dr. Medina.

Dr. Medina is prohibited from rendering medical treatment and care to individuals who have suffered work-related injuries or illnesses. Medical reports submitted by Dr. Medina for treatment rendered prior to June 30, 2009, are valid, but are invalid for any treatment rendered on or after that date. Requests to cross-examine Dr. Medina regarding treatment he rendered prior to June 30, 2009, should not be denied due to the surrender of his license to practice medicine.

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