| | Physician Last Name: | Verbeck, Jr |
| | Physician First Name: | Samuel |
| | Physician Middle Name: | S. |
| | Address: | Address redacted |
| | License Number: | 004138 |
| | License Type: | PA |
| | Year of Birth: |
1957
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| | Effective Date: | 12/29/2021 |
| | Action Description for DOH Webpage: | License surrender. This modification order permits the physician assistant to surrender their physician assistant license and precludes them from performing medical services in New York State. This surrender shall substitute for so much of the remaining penalty to serve and releases the physician assistant from the fees and registration requirement of the New York State Education Department. |
| | Misconduct Description for DOH Webpage: | This order is a modification of the terms and conditions previously imposed under BPMC Order #18-105 that went into effect on May 16, 2018 and does not constitute a new disciplinary action. The physician assistant did not contest the charge of committing professional misconduct by failing to maintain accurate patient medical records.
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| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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