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FILED: NEW YORK COUNTY CLERK 11/15/2019 12:58 PM INDEX NO. 805238/2019
NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 11/15/2019
REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,)
New York Supreme COURT, COUNTY OF New York
Index No: 805238/2019 Date Index Issued: 07/29/2019 For Court Use Only:
IAS EntryDate
Ralph V. Brown
Judge Assigned
-against- Plaintiff(s)/Petitioner(s)
Boback M. Beiüükhiin M.D., Lenox HillHospital,Northwell Health
RJIFiled Date
Defendant(s)/Respondent'c)
COMMERCIAL MATRIMONIAL
O Contested
O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.)
NOTE: If there are children under the age of 18, complete and attach the
Contract MATRIMONDALRJRAddendum (UCS-840M).
O Insurance(where insurance company is a party, except =±!tet!en)
For UncontestedMatn'monialactions, use the UncontestedDivorce RJi(UD-13).
O UCC(includes sales and negotiable instruments)
O Other Commercial(specify):
TORTS
NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos
O Child Victims Act
REAL PROPERTY: Specify how many properties the application includes: . .
Envronmenta! (specify):
O Condemnation Medical,Dental, or Podiatric Malpractice
O O iniut-niiai
Mortgage Foreclosure(specify): O Commercial O Motor Vehicle
Property Address: O Products Liability (specify):
O Other Negligence(specify):
NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner-
occupied residential property or owner-occupiedcondominium, complete and
O Other ProfessionalMalpractice (specify):
attach the FORECLOSURERJRADDENDUM (UCS-840F). Other Tort (specify):
O
Tax Certiorari - Section: Block: Lot:
Tax Foreclosure SPECIAL PROCEEDINGS
Other Real Property (specify): O CPLRArticle 75 (Arbitration)
[see NOTE in COMMERCIALsection]
O
O CPLRArticle 78 (Body or Officer)
OTHER MATTERS
O Election Law
O Certificate of Incorporatior "Wr'
"T. [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder
O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law)
O HabeasCorpus O MHLArticle 10 (Sex Offender Confinement-Initial)
O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review)
O Mechanic'sLien MHLArticle 81 (Guardianship)
O NameChange O Other Mental Hygiene (specify):
Pistol Permit Revocation Hearing O Other Special Proceeding(specify):
O Saleor Financeof Religious/Not-for-ProfitProperty
O Other (specify):
STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated.
YES NO
Hasa summons and complaint or summonswith notice been filed? O 07/26/2019
If yes, date filed:
Hasa summons and complaint or summonswith notice been served? O 08/12/2019
If yes, date served:
Is this action/proceeding being filed post-judgment? O If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2t!on
where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder Application
O Note of Issue/Certificateof Readiness
09 16/2019
Date Issuejoined:
Notice of Medical, Dental, or Podiatric Malpractice
Notice of Motion Relief Requested: Return Date:
O
Notice of Petition Relief Requested: Return Date:
O
Order to ShowCause Relief Requested: Return Date:
O
Other Ex ParteApplication Relief Requested:
O
O PoorPersonApplication
O Requestfor Preliminary Conference
O ResidentialMortgage ForeclosureSettlement Conference
O Writ of HabeasCorpus
O Other (specify):
1 of 2
FILED: NEW YORK COUNTY CLERK 11/15/2019 12:58 PM INDEX NO. 805238/2019
RELATED CASES: actions.
List any related For Matrimonial
cases, list any
relatedcriminalor Family
Court cases.If none,
leaveblank.If additional
space
NYSCEF DOC. NO. 17is required,
complete and attachtheRJI Addendum (UCS-840A). RECEIVED NYSCEF: 11/15/2019
Case Title Index/Case Number Court Judge (ifassigned) Relationship to instantcase
For parties
withoutan attorney,
check the "Un-Rep"box and entertheparty's phone number and email in the
space
PARTIES: address,
provided.If additional
spaceis required,
complete and attach
the RJI Addendum (UCS-840A).
Un- Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Carriers
Rep List parties in same order as listed in the
For represented parties, provide attorney's name, firm name, address, phone
For each defendant,
For each defendant,
caption and indicate roles (e.g., plaintiff,
and email. For unrepresented parties, provide party's address, phone and
indicate if issue has
indicate insurance
defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable.
Name: Brown, RalphV· SHERRIPLOTKIN,RheingoldGiuffra Ruffo & Plotkin LLP,551 Fifth Avenue 29th
Floor, New York, NY 10176, 2126841880, splotkin@rheingoldlaw.com
2 YES 0 NO
Role(s):Plaintiff/Petitioner
Name: Berookhim, BobackM· SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park
Avenue 7th Floor, New York, NY 10016, 212-286-8585, 2 YES O NO
Role(s):Defendant/Respondent szimmerman@hpmb.com
Name: Lenox Hill Hospital SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park
Avenue 7th Floor, New York, NY 10016, 212-286-8585, O YES O NO
Role(s):Defendant/Respondent szimmerman@hpmb.com
Name: Northwell Health SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park
Avenue 7th Floor, New York, NY 10016, 212-286-8585, 2 YES 0 NO
Role(s):Defendant/Respondent szimmerman@hpmb.com
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
0 YES 0 NO
Role(s):
Name:
O YES O NO
Role(s):
Name:
O YES O NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR
PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FORJUDICIAL INTERVENTION BEEN PREVIOUSLY FILED INTHIS
ACTION OR PROCEEDING.
Dated: 11/15/2019 SHERRI L PLOTKIN
Signature
2310555 SHERRI L PLOTKIN
Attorney Registration Number PrintName
This form was generated by NYSCEF
2 of 2
Preview
FILED: NEW YORK COUNTY CLERK 11/15/2019 12:58 PM INDEX NO. 805238/2019 NYSCEF DOC. NO. 17 RECEIVED NYSCEF: 11/15/2019 REQUEST FOR JUDICIAL INTERVENTION 58,4g°g1,) New York Supreme COURT, COUNTY OF New York Index No: 805238/2019 Date Index Issued: 07/29/2019 For Court Use Only: IAS EntryDate Ralph V. Brown Judge Assigned -against- Plaintiff(s)/Petitioner(s) Boback M. Beiüükhiin M.D., Lenox HillHospital,Northwell Health RJIFiled Date Defendant(s)/Respondent'c) COMMERCIAL MATRIMONIAL O Contested O BusinessEntity (includes corporations, partnerships, LLCs,LLPs,etc.) NOTE: If there are children under the age of 18, complete and attach the Contract MATRIMONDALRJRAddendum (UCS-840M). O Insurance(where insurance company is a party, except =±!tet!en) For UncontestedMatn'monialactions, use the UncontestedDivorce RJi(UD-13). O UCC(includes sales and negotiable instruments) O Other Commercial(specify): TORTS NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCIALDEVISIONRJRADDENDUM (UCS-840C). Asbestos O Child Victims Act REAL PROPERTY: Specify how many properties the application includes: . . Envronmenta! (specify): O Condemnation Medical,Dental, or Podiatric Malpractice O O iniut-niiai Mortgage Foreclosure(specify): O Commercial O Motor Vehicle Property Address: O Products Liability (specify): O Other Negligence(specify): NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- occupied residential property or owner-occupiedcondominium, complete and O Other ProfessionalMalpractice (specify): attach the FORECLOSURERJRADDENDUM (UCS-840F). Other Tort (specify): O Tax Certiorari - Section: Block: Lot: Tax Foreclosure SPECIAL PROCEEDINGS Other Real Property (specify): O CPLRArticle 75 (Arbitration) [see NOTE in COMMERCIALsection] O O CPLRArticle 78 (Body or Officer) OTHER MATTERS O Election Law O Certificate of Incorporatior "Wr' "T. [see NOTE in COMMERCIALsection] Extreme Risk ProtectionOrder O Emergency MedicalTreatment MHLArticle 9.60 (Kendra's Law) O HabeasCorpus O MHLArticle 10 (Sex Offender Confinement-Initial) O LocalCourt Appeal MHLArticle 10 (Sex Offender Confinement-Review) O Mechanic'sLien MHLArticle 81 (Guardianship) O NameChange O Other Mental Hygiene (specify): Pistol Permit Revocation Hearing O Other Special Proceeding(specify): O Saleor Financeof Religious/Not-for-ProfitProperty O Other (specify): STATUS OF ACTION OR PROCEEDING: AnswerYESor NOfor every question and enter additional information where indicated. YES NO Hasa summons and complaint or summonswith notice been filed? O 07/26/2019 If yes, date filed: Hasa summons and complaint or summonswith notice been served? O 08/12/2019 If yes, date served: Is this action/proceeding being filed post-judgment? O If yes, judgment date: NATURE OF JUDICIAL INTERVENTION: Checkone box only and enter additional info=2t!on where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder Application O Note of Issue/Certificateof Readiness 09 16/2019 Date Issuejoined: Notice of Medical, Dental, or Podiatric Malpractice Notice of Motion Relief Requested: Return Date: O Notice of Petition Relief Requested: Return Date: O Order to ShowCause Relief Requested: Return Date: O Other Ex ParteApplication Relief Requested: O O PoorPersonApplication O Requestfor Preliminary Conference O ResidentialMortgage ForeclosureSettlement Conference O Writ of HabeasCorpus O Other (specify): 1 of 2 FILED: NEW YORK COUNTY CLERK 11/15/2019 12:58 PM INDEX NO. 805238/2019 RELATED CASES: actions. List any related For Matrimonial cases, list any relatedcriminalor Family Court cases.If none, leaveblank.If additional space NYSCEF DOC. NO. 17is required, complete and attachtheRJI Addendum (UCS-840A). RECEIVED NYSCEF: 11/15/2019 Case Title Index/Case Number Court Judge (ifassigned) Relationship to instantcase For parties withoutan attorney, check the "Un-Rep"box and entertheparty's phone number and email in the space PARTIES: address, provided.If additional spaceis required, complete and attach the RJI Addendum (UCS-840A). Un- Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Carriers Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant; 3rdparty plaintiff, etC.) email. beenjoined. carrier, if applicable. Name: Brown, RalphV· SHERRIPLOTKIN,RheingoldGiuffra Ruffo & Plotkin LLP,551 Fifth Avenue 29th Floor, New York, NY 10176, 2126841880, splotkin@rheingoldlaw.com 2 YES 0 NO Role(s):Plaintiff/Petitioner Name: Berookhim, BobackM· SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park Avenue 7th Floor, New York, NY 10016, 212-286-8585, 2 YES O NO Role(s):Defendant/Respondent szimmerman@hpmb.com Name: Lenox Hill Hospital SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park Avenue 7th Floor, New York, NY 10016, 212-286-8585, O YES O NO Role(s):Defendant/Respondent szimmerman@hpmb.com Name: Northwell Health SCOTTZIMMERMAN,HEIDELL,PITTONI,MURPHY& BACH,LLP,99 Park Avenue 7th Floor, New York, NY 10016, 212-286-8585, 2 YES 0 NO Role(s):Defendant/Respondent szimmerman@hpmb.com Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): Name: 0 YES 0 NO Role(s): Name: O YES O NO Role(s): Name: O YES O NO Role(s): I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FORJUDICIAL INTERVENTION BEEN PREVIOUSLY FILED INTHIS ACTION OR PROCEEDING. Dated: 11/15/2019 SHERRI L PLOTKIN Signature 2310555 SHERRI L PLOTKIN Attorney Registration Number PrintName This form was generated by NYSCEF 2 of 2