Subject Numbers Regarding Health Provider Authorizations

Authorization No. 131355-0W

August 28, 2015

Please be advised that Dr. Mark M. Chalom has resigned his authorization to treat injured workers in the New York State workers' compensation system effective August 24, 2015. Dr. Chalom's last known practice address is 1231 Congress Street, Ogdensberg, New York 13669.

Dr. Chalom is prohibited from rendering treatment and care to injured workers. Reports submitted by Dr. Chalom for services rendered prior to August 24, 2015, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Chalom for services rendered prior to August 24, 2015, 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.