| | Physician Last Name: | Alpine Medical |
| | Physician First Name: | LLC |
| | Physician Middle Name: | |
| | Address: | c/o Ivan Van Leer, Esq.
132 Nassau Street
New York, New York 10038 |
| | License Number: | 186086 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 12/19/2006 |
| | Action Description for DOH Webpage: | Revocation of Articles of Organization. |
| | Misconduct Description for DOH Webpage: | The Corporation was rendered in violation of New York State Public Health Law Section 1203(a) and (b) and section 1204(a) of the Limited Liability Company Law due to the surrender of the sole shareholder's medical license. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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