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Subject Number 046-332 Notice of Voluntary Withdrawal of IME Entity's Registration

Subject Numbers Regarding Health Provider Authorizations

June 25, 2009

Objective Medical Evaluation, P.C. (Registration No. 010040)

Effective May 1, 2009, Objective Medical Evaluation, P.C., voluntarily withdrew its designation as an entity registered to derive income from independent medical examinations in workers' compensation cases. This withdrawal is made pursuant to Section 13-n of the Workers' Compensation Law and 12 NYCRR 300.2(e) and is permanent. The entity's last known address is:

Objective Medical Evaluation, P.C.
240 West Old Country Road, Suite 3
Hicksville, New York 11801

As of the effective date of this voluntary withdrawal, the entity named above is permanently prohibited from deriving income from independent medical examinations in workers' compensation cases. Income derived by this entity for examinations conducted prior to May 1, 2009, is allowed.

Any questions regarding this matter should be referred to the Office of General Counsel at (518) 486-9564.

Zachary S. Weiss
Chair