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Subject Number 046-1176 Voluntary Resignation of Dr. John A. Mitamura

Subject Numbers Regarding Health Provider Authorizations

Authorization No. 160355-4B

June 10, 2019

Please be advised that Dr. John A. Mitamura has resigned his authorizations to treat injured workers and to perform independent medical examinations in the New York State workers’ compensation system effective June 7, 2019. Dr. Mitamura’s last known practice address is:

20 Beacon Hill Drive
Dobbs Ferry, New York 10522

Dr. Mitamura is prohibited from rendering treatment and care to injured workers, from performing independent medical examinations, and from conducting reviews of records regarding variance requests pursuant to 12 NYCRR § 324.3(b)(2)(ii)(a). Reports submitted by Dr. Mitamura for services rendered prior to June 7, 2019, are valid, but are invalid for any services rendered on or after that date. Requests to cross-examine Dr. Mitamura for services rendered prior to June 7, 2019, should not be denied due to the resignation of his authorizations.

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

Clarissa M. Rodriguez
Chair