Subject Numbers Regarding Health Provider Authorizations

Authorization No. 185894-3W

May 9, 2013

Please be advised that Robert Plachy, M.D., has resigned his authorization to treat injured workers in the New York State workers' compensation system effective December 27, 2012. Dr. Plachy's last known business address is 145 Main Street, Amagansett, New York, 11930.

Dr. Plachy is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Plachy for services rendered prior to December 27, 2012, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Plachy for services rendered prior to December 27, 2012, should not be denied due to his voluntary resignation.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.