Subject Numbers Regarding Health Provider Authorizations

Authorization No. 209583-4W

August 19, 2013

Please be advised that Dr. Anthony Ippolito has resigned his authorization to treat injured workers in the New York State workers' compensation system effective August 9, 2013. Dr. Ippolito's last known practice address is 25 Jefferson Landing, Port Jefferson, NY 11777.

Dr. Ippolito is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Ippolito for services rendered prior to August 9, 2013, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Ippolito for services rendered prior to August 9, 2013, should not be denied due to his resignation.

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