Subject Numbers Regarding Health Provider Authorizations

Authorization No. 116507-5W

July 29, 2013

Please be advised that Dr. Jose Banzon has been removed from the list of authorized providers based on information provided by the New York State Education Department indicating that Dr. Banzon does not currently have an active license to practice medicine in New York State.

Pursuant to Workers' Compensation Law § 13-b, a provider must be licensed and registered with the New York State Education Department in order to maintain a Workers' Compensation Board authorization(s). Therefore, Dr. Banzon's authorization to treat injured workers within the New York State workers' compensation system has been removed effective May 17, 2013. Dr. Banzon's last known practice address is 113 Franklin Avenue, Franklin Square, New York 11010.

Dr. Banzon is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Banzon for services rendered prior to May 17, 2013, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Banzon for services rendered prior to May 17, 2013, should not be denied due to the removal of his/her authorization.

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