Subject Numbers Regarding Health Provider Authorizations

October 29, 2009

Authorization No. 090341-9W

Please be advised that, effective August 24, 2009, Jerome V. Jakubiak, M.D., permanently surrendered his license to practice medicine to the New York State Department of Health, Board of Professional Medical Conduct pursuant to New York State Public Health Law Section 230.13. No current business address is available for Dr. Jakubiak.

Dr. Jakubiak 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. Jakubiak for treatment rendered prior to August 24, 2009, are valid, but are invalid for any treatment rendered on or after that date. Requests to cross-examine Dr. Jakubiak regarding treatment he rendered prior to August 24, 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.