Preview
INDEX NO. 158348/2012
NYSCEREQUEST FOR JUDICIAL INTERVENTION e-OT
Ucs-840 (7/2012) AS Entry Date = |
Supreme COURT, COUNTY OF. New York
Judge Assigned
Index No: 158348/12 Date Index issued 11/28/2012
TON: iJ] Date: -
ets
AMERICAN TRANSIT INSURANCE COMPANY
Plaintiff(s)/Petitioner(s)
~against-
STEVEN CASTOR, A & F MEDICAL, P.C., ACTIVE CARE MEDICAL SUPPLY CORPORATION, BROMER MEDICAL P.C., ELITE REHAB PHYSICAL
{THERAPY P.C., FYZ ACUPUNCTURE, P.C., HAOYUN MEDICAL CARE P.C,, INTEGRATIVE PAIN MEDICINE P.C., KAPPA MEDICAL, P.C,, TOTAL
JHEALTH CHIROPRACTIC P.C.,, WES PSYCHOLOGICAL SERVICES P.C,,
Defendant(s)/Respondient(
OGEEDING INE: ec
IMONIAL COMMERCIAL
© Contested © Business Entity (including corporations, partnerships, LLCs, cic)
NOTE: For all Matrimonial actions where the parties have children under © contract
the age of 18, complete and attach the MATRIMONIAL RJl Addendum. © Insurance (where insurer is a party, except arbitration)
For Uncontested Matrimonial actions, use RWI form UD-13. © ucc (including sales, negotiable instruments)
=
TORTS” © other Commercial
© Asbestos (specify)
© Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR §
© Environmental: 202.70{d)], complete and attach the COMMERCIAL DIV RJl Addendum.
(epee REAL'PROPERTY: - How maniy-properties daes the application include?
© medical, Dental, or Podiatric Malpractice © Condemnation
© Motor Vehicle oO Morigage Foreclosure {spacity): © Residentat © Commercial
© Products Liability: Property Address
(specity} Stroet Address City Stale Zip
© other Negligence: NOTE: For Morigage Foreclosure actions involving a one- to four-family,
{specity} owner-occupied, residential property, or an owner-occupied
© other Professional Malpractice: condominium, complete and altach the FORECLOSURE RJl Addendum.
(speci) O Tax Centiorari - Section: Block: Lot:
© other Tort © Tax Foreciosure
(specify) Jo Other Real Property:
OTHER MATTERS (specify)
© Cerificate of Incorporation/Dissolution [see NOTE underCommercial] SPEGIAL PROCEEDINGS:
© Emergency Medical Treatment © CPLR Article 75 (Arbitration) [see NOTE onder ‘Commercial
Habeas Corpus © CPLR Article 78 (Body or Officer)
© Local Court Appeal © Election Law
© Mechanic's Lien © MHL Article 9.60 (Kendra's Law)
© Name Change © MHL Article 10 (Sex Offender Confinement-Iniial)
© Pistol Permit Revocation Hearing © MHL Article 10 (Sex Offender Confinement-Review)
© Sale or Finance of Religious/Not-for-Profit Property © MHL Article 81 (Guardianship)
© othertnsurance © other Mental Hygiene:
(spacily) (spacify}
© Other Special Proceeding
(specify)
AGTION: EEDIN' Answer: YES RY question EAN additional mation whel ated.
YES:
Has a summons and complaint or summons winotice been filed? Oo 90 If yes, date filed:
Has a summons and complaint or summons w/notice been served? o 90 If yes, date server
\s this acllon/proceeding being filed post-judgment? Oo 0 I yes, judgment date:
RI DI jebk: Eb additions information. where indic
“C) infant's Compromise
© Note of Issue and/or Certificate of Readiness
© Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined:
© Notice of Motion Rellef Sought;/udament- Default Retum Date: 05/28/2013
© Notice of Petition Relief Sought: Retum Date:
© order to Show Cause Relief Sought: Retum Date:
© other Ex Parte Application Rellef Sought: ee
© Poor Person Application
oO Request for Preliminary Conference
© Residential Mortgage Foreclosure Settlement Conference
© Writ of Habeas Corpus
© Other (specify
=
any lon relate {ior Family
GA requ
adaltia; completa: all W:Addendut ion leave ei
ase 7 Ind ‘No. Court Judge (if'assigned) : Relations! stant Case
TE ditiai lired; complete.and-altachthe: idendum.
Parties: Attorneys and/or Unrepresented Litigant:
Issue
ist parlies in captio rder: Provide attorney name, firm name, business address, phone number and e-mail done
~ Insurance
icate Gs address of all allomeys that have appeared in the case. For unrepresented eters)
laintit |litigants, provide address, phone number and e-mall address. (YIN):
AMERICAN:TRANSIT INSURANCE COMPAR Tuttolomondo Giovanna
Last Namo First Wana
Oyves
Law Office of James F, Sullivan
First Name
o Primary Role:
'2 Duane Street, 7th Floor
Firm Name
New York New York ‘007
Plaintiff Strect Address City State Ip
Secandary Rate {if any} KDNo
pe 212) 374-0008
Fox esmall
ICASTOR
Last Name Last Name First Namo
STEVEN
yes
First Name Firm Name
Primary Role:
Defendant Street Address City State ap
Secondary Role (it any}; K=)No
Phone Fox eomall
[A & F MEDICAL, P.C,,
jst Nama. Last Nama First Name
Dyes
First Nama Firm Name
Primary Role:
Defendant ‘Street Address City Stala zip
Secondary Role (If any) K@)No
Phono Fox e-mall
ACTIVE CAREMEDICAL SUPPLY CORPORS
Last Name First Name
Ores
First Namo Firm Namo
Primary Role:
Defendant Stroot Address City. Stato 2p
Secondary Role (If any}: Ke)No
Phono Fox
i AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTI
(\ emg
AS HOTED ABOVE, THERE ARE AND HAVE
BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUD! INTERVENTION PREVIOUSLY BEEN FILED IN
\
THIS ACTION OR PROCEEDING.
Dated; 04/2/2013
\ \e SIGNATURE
4381703 anna Tuttolomondo
ATTORNEY REGISTRATION NUMBER ¥ ‘PRINT OR TYPE NAME
Form
PrintForm
Request for Judicial Intervention Addendum UCS-840A (7/2012)
Supreme
COURT, COUNTY OF. New York Index No: 158348/12
For use when additional space is needed to provide party or related case information.
jairtie pan altoy 1d imbet :o-t
‘Attorneys:and/or: Unreprasented Litigants:
Un-}List parties: ptlon order. and Issue
Rep indi pal
Provide attorney fname, firm name, businéss address, phone number and e-mail
es} (08 defendant, Jadcress ofall ailomeys thal have appeared Inthe case, For unrepresented Joined insurance Carriers): .:
Srd-p: ty provide address, Phone number, and.e-mail address, YIN):
BROMER MEDICAL P.C,,
ast Name Last Name First Name
\Oves
First Name Firm Name
Primary Role:
Pefendant Stract Addrass city State zp
‘Secondary Role (if any): Kno
Phone Fax eamall
ELITE REHAB PHYSICAL THERAPY P.C.,
Last Name First Name
Kves
First Namo Fiem Name
Primary Rote:
Defendant ‘Street Address city State
Sccandary Role {if any): Ke)No
Phone Fax, e-mail
FYZ ACUPUNCTURE, P.C,,
Last Name Lost tame First Name
Kyes
First Name Firm Name
Primary Rota:
Defendant Strat Address. city State ap
Secondary Rale (If any}: Keno
Phone Fax eamalt
HACYUN MEDICAL CARE P.C.
Last Nama Last Nama First Name
YES
First Name Firms Name
Primary Role:
Defendant Stroot Addrass chy State 2p
‘Secondary Role (if any): no
Phone Fax esnall
INTEGRATIVE PAIN MEDICINE P.C.,
Lost Name First Name
KES
First Name Firm Name
Primary Rote:
Defendant Stroot Addross: chy State 2p
Sucondary Role {if any): Kno
Phono Fax paral
KAPPA MEDICAL, P.C,
Name Last Nama First Namo
KDYES
First Name Firm Name
Primary Rote:
Pefendant Street Address. City State Zp
Secondary Role (if any): Ke)NO
Phone Fax e-mall
jrelatedia ion Z1iclude-any-ralat imine ind/ar-Family Court case
‘Case Title lind xiCase No. dudge (if. aeclgied) Relationship ‘to: Instant Case:
_ Print For
Request for Judicial Intervention Addendum UCS-340A (7/2012)
Supreme
COURT, COUNTY OF. New York Index No: 158348/12
For use additional ice Is needed to provide party or related case information.
ttoi ber: ss.in ace.
Attorneys:and/or Unrepresented Litigant
Un- parties in caption ordér‘and. Provide attorney name, firm name, tusiness address, phone umber and e-mail Issue"
Rep |indicate-paity role(s) (eg defenda appeared in the case... For unrepresented
address: ofall attorneys that hay Joined Insurance Carrir(s} ::
lard:party: igans, provide addrass, phone number and e-mall address. (vin
TOTAL HEALTH citRormacnc PC,
Last Name First Name
(ves
First Name Firm Name
Primary Rote:
Defendant Straet Address city Stato zip
Secondary Role (if any}: K)No
Phone Fox e-mail
Last Namo: Last Name First Name
{yes
Oo First Name
Primary Role:
Finn Name
Street Address cy Stato Zp
Sccandary Role (If any): Kno
Phane Fax, eamalt
Last Name Last Nama First Name
(ves
Firat Namo Firm Name
Primary Rolo:
Street Address city Stata zip
Secondary Rala (If any} Kno
Phone Fax e-matl
Last Nama Last Namo First Name
ves
First Name Firm Name
Primary Riole:
Stroot Address, city State ip
Secondary Role (If any): Ono
Phone Fax axmall
Last Name Last Name First Namo
ves
First Namo Firm Name
Primary Role:
Stront Addrass city State Zp
Secondary Role (IF ony): no
Phone Fax e-mail
Last Name Last Nemo First Name
(Dyes
Firet Name Firm Namo
Primary Rote:
tract Address; city Stata Zip
Secondary Role (if any}: (Ono
Phone Fax exmall
te ‘actions; jonlal:act lors iny related criminal-and/o Fam Ourt cas
Ca itl Index/Case:No. | Judge assigned) Relationship toInstant Case.
Preview
INDEX NO. 158348/2012 NYSCEREQUEST FOR JUDICIAL INTERVENTION e-OT Ucs-840 (7/2012) AS Entry Date = | Supreme COURT, COUNTY OF. New York Judge Assigned Index No: 158348/12 Date Index issued 11/28/2012 TON: iJ] Date: - ets AMERICAN TRANSIT INSURANCE COMPANY Plaintiff(s)/Petitioner(s) ~against- STEVEN CASTOR, A & F MEDICAL, P.C., ACTIVE CARE MEDICAL SUPPLY CORPORATION, BROMER MEDICAL P.C., ELITE REHAB PHYSICAL {THERAPY P.C., FYZ ACUPUNCTURE, P.C., HAOYUN MEDICAL CARE P.C,, INTEGRATIVE PAIN MEDICINE P.C., KAPPA MEDICAL, P.C,, TOTAL JHEALTH CHIROPRACTIC P.C.,, WES PSYCHOLOGICAL SERVICES P.C,, Defendant(s)/Respondient( OGEEDING INE: ec IMONIAL COMMERCIAL © Contested © Business Entity (including corporations, partnerships, LLCs, cic) NOTE: For all Matrimonial actions where the parties have children under © contract the age of 18, complete and attach the MATRIMONIAL RJl Addendum. © Insurance (where insurer is a party, except arbitration) For Uncontested Matrimonial actions, use RWI form UD-13. © ucc (including sales, negotiable instruments) = TORTS” © other Commercial © Asbestos (specify) © Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR § © Environmental: 202.70{d)], complete and attach the COMMERCIAL DIV RJl Addendum. (epee REAL'PROPERTY: - How maniy-properties daes the application include? © medical, Dental, or Podiatric Malpractice © Condemnation © Motor Vehicle oO Morigage Foreclosure {spacity): © Residentat © Commercial © Products Liability: Property Address (specity} Stroet Address City Stale Zip © other Negligence: NOTE: For Morigage Foreclosure actions involving a one- to four-family, {specity} owner-occupied, residential property, or an owner-occupied © other Professional Malpractice: condominium, complete and altach the FORECLOSURE RJl Addendum. (speci) O Tax Centiorari - Section: Block: Lot: © other Tort © Tax Foreciosure (specify) Jo Other Real Property: OTHER MATTERS (specify) © Cerificate of Incorporation/Dissolution [see NOTE underCommercial] SPEGIAL PROCEEDINGS: © Emergency Medical Treatment © CPLR Article 75 (Arbitration) [see NOTE onder ‘Commercial Habeas Corpus © CPLR Article 78 (Body or Officer) © Local Court Appeal © Election Law © Mechanic's Lien © MHL Article 9.60 (Kendra's Law) © Name Change © MHL Article 10 (Sex Offender Confinement-Iniial) © Pistol Permit Revocation Hearing © MHL Article 10 (Sex Offender Confinement-Review) © Sale or Finance of Religious/Not-for-Profit Property © MHL Article 81 (Guardianship) © othertnsurance © other Mental Hygiene: (spacily) (spacify} © Other Special Proceeding (specify) AGTION: EEDIN' Answer: YES RY question EAN additional mation whel ated. YES: Has a summons and complaint or summons winotice been filed? Oo 90 If yes, date filed: Has a summons and complaint or summons w/notice been served? o 90 If yes, date server \s this acllon/proceeding being filed post-judgment? Oo 0 I yes, judgment date: RI DI jebk: Eb additions information. where indic “C) infant's Compromise © Note of Issue and/or Certificate of Readiness © Notice of Medical, Dental, or Podiatric Malpractice Date Issue Joined: © Notice of Motion Rellef Sought;/udament- Default Retum Date: 05/28/2013 © Notice of Petition Relief Sought: Retum Date: © order to Show Cause Relief Sought: Retum Date: © other Ex Parte Application Rellef Sought: ee © Poor Person Application oO Request for Preliminary Conference © Residential Mortgage Foreclosure Settlement Conference © Writ of Habeas Corpus © Other (specify = any lon relate {ior Family GA requ adaltia; completa: all W:Addendut ion leave ei ase 7 Ind ‘No. Court Judge (if'assigned) : Relations! stant Case TE ditiai lired; complete.and-altachthe: idendum. Parties: Attorneys and/or Unrepresented Litigant: Issue ist parlies in captio rder: Provide attorney name, firm name, business address, phone number and e-mail done ~ Insurance icate Gs address of all allomeys that have appeared in the case. For unrepresented eters) laintit |litigants, provide address, phone number and e-mall address. (YIN): AMERICAN:TRANSIT INSURANCE COMPAR Tuttolomondo Giovanna Last Namo First Wana Oyves Law Office of James F, Sullivan First Name o Primary Role: '2 Duane Street, 7th Floor Firm Name New York New York ‘007 Plaintiff Strect Address City State Ip Secandary Rate {if any} KDNo pe 212) 374-0008 Fox esmall ICASTOR Last Name Last Name First Namo STEVEN yes First Name Firm Name Primary Role: Defendant Street Address City State ap Secondary Role (it any}; K=)No Phone Fox eomall [A & F MEDICAL, P.C,, jst Nama. Last Nama First Name Dyes First Nama Firm Name Primary Role: Defendant ‘Street Address City Stala zip Secondary Role (If any) K@)No Phono Fox e-mall ACTIVE CAREMEDICAL SUPPLY CORPORS Last Name First Name Ores First Namo Firm Namo Primary Role: Defendant Stroot Address City. Stato 2p Secondary Role (If any}: Ke)No Phono Fox i AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTI (\ emg AS HOTED ABOVE, THERE ARE AND HAVE BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUD! INTERVENTION PREVIOUSLY BEEN FILED IN \ THIS ACTION OR PROCEEDING. Dated; 04/2/2013 \ \e SIGNATURE 4381703 anna Tuttolomondo ATTORNEY REGISTRATION NUMBER ¥ ‘PRINT OR TYPE NAME Form PrintForm Request for Judicial Intervention Addendum UCS-840A (7/2012) Supreme COURT, COUNTY OF. New York Index No: 158348/12 For use when additional space is needed to provide party or related case information. jairtie pan altoy 1d imbet :o-t ‘Attorneys:and/or: Unreprasented Litigants: Un-}List parties: ptlon order. and Issue Rep indi pal Provide attorney fname, firm name, businéss address, phone number and e-mail es} (08 defendant, Jadcress ofall ailomeys thal have appeared Inthe case, For unrepresented Joined insurance Carriers): .: Srd-p: ty provide address, Phone number, and.e-mail address, YIN): BROMER MEDICAL P.C,, ast Name Last Name First Name \Oves First Name Firm Name Primary Role: Pefendant Stract Addrass city State zp ‘Secondary Role (if any): Kno Phone Fax eamall ELITE REHAB PHYSICAL THERAPY P.C., Last Name First Name Kves First Namo Fiem Name Primary Rote: Defendant ‘Street Address city State Sccandary Role {if any): Ke)No Phone Fax, e-mail FYZ ACUPUNCTURE, P.C,, Last Name Lost tame First Name Kyes First Name Firm Name Primary Rota: Defendant Strat Address. city State ap Secondary Rale (If any}: Keno Phone Fax eamalt HACYUN MEDICAL CARE P.C. Last Nama Last Nama First Name YES First Name Firms Name Primary Role: Defendant Stroot Addrass chy State 2p ‘Secondary Role (if any): no Phone Fax esnall INTEGRATIVE PAIN MEDICINE P.C., Lost Name First Name KES First Name Firm Name Primary Rote: Defendant Stroot Addross: chy State 2p Sucondary Role {if any): Kno Phono Fax paral KAPPA MEDICAL, P.C, Name Last Nama First Namo KDYES First Name Firm Name Primary Rote: Pefendant Street Address. City State Zp Secondary Role (if any): Ke)NO Phone Fax e-mall jrelatedia ion Z1iclude-any-ralat imine ind/ar-Family Court case ‘Case Title lind xiCase No. dudge (if. aeclgied) Relationship ‘to: Instant Case: _ Print For Request for Judicial Intervention Addendum UCS-340A (7/2012) Supreme COURT, COUNTY OF. New York Index No: 158348/12 For use additional ice Is needed to provide party or related case information. ttoi ber: ss.in ace. Attorneys:and/or Unrepresented Litigant Un- parties in caption ordér‘and. Provide attorney name, firm name, tusiness address, phone umber and e-mail Issue" Rep |indicate-paity role(s) (eg defenda appeared in the case... For unrepresented address: ofall attorneys that hay Joined Insurance Carrir(s} :: lard:party: igans, provide addrass, phone number and e-mall address. (vin TOTAL HEALTH citRormacnc PC, Last Name First Name (ves First Name Firm Name Primary Rote: Defendant Straet Address city Stato zip Secondary Role (if any}: K)No Phone Fox e-mail Last Namo: Last Name First Name {yes Oo First Name Primary Role: Finn Name Street Address cy Stato Zp Sccandary Role (If any): Kno Phane Fax, eamalt Last Name Last Nama First Name (ves Firat Namo Firm Name Primary Rolo: Street Address city Stata zip Secondary Rala (If any} Kno Phone Fax e-matl Last Nama Last Namo First Name ves First Name Firm Name Primary Riole: Stroot Address, city State ip Secondary Role (If any): Ono Phone Fax axmall Last Name Last Name First Namo ves First Namo Firm Name Primary Role: Stront Addrass city State Zp Secondary Role (IF ony): no Phone Fax e-mail Last Name Last Nemo First Name (Dyes Firet Name Firm Namo Primary Rote: tract Address; city Stata Zip Secondary Role (if any}: (Ono Phone Fax exmall te ‘actions; jonlal:act lors iny related criminal-and/o Fam Ourt cas Ca itl Index/Case:No. | Judge assigned) Relationship toInstant Case.