Preview
FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020
NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 11/20/2020
"CS"
REQUEST FOR JUDICIAL INTERVENTION (rev. unzwzusw
New York ';üpic;-c COURT, COUNTY OF New York
Index No: 154154/2020 Date Index Issued: 06/17/2020 For Court Use Only:
CAI er t eet. IAS EntryDate
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
Judge Assigned
-against- Plaintiff's),met|t|oner(s)
NEW SENSE ACUPUNCTURE, P.C.,RIU CHIROPRACTIC P.C.,CITIMEDICAL I, PLLC,LIDA PHYSICAL THERAPY &
ACUPUNCTURE, PLLC, MC PHYSICAL THERAPY, P.C.,TRii30RO MEDICAL SERVICES, P.C.,HAPPY APPLE MEDICAL RJIFiled Date
SERVICES, P.C.,MALVINA DRUG CORP., LONGEVITY MEDICAL SUPPLY, INC., JA PHYSICAL THERAPY, P.C.,MILASI...
D±nd=nt(c),"espondent(s)
COMMERCIAL MATRIMONIAL
O Contested
O BusinessEntity (includes corporations, pe-+nerchine LLCs,LLps,etC.)
NOTE: If there are children under the age of 18, complete and attach the
Contract MATRIMONIAL RJIAddendum (UCS-84OM).
O Insurance(where insurance company is a party, except arbitration) . .
For UncontestedMatnmonial actions, use the UncontestedDivorce RJi(UD-13).
O UCC(includes sales and negotiable instruments)
Other Commercial(specify):
| TORTS
NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d),
complete and attach the COMMERCIALDIVISION RJIADDENDUM (UCS-840C). Asbestos
O Child Victims Act
REAL FRGFERTY: Specify how many properties the application includes:
O Condemnation Medical,Dental, or Podiatric Malpractice
O O nacidential
Mortgage Foreclosure(specify): O Commercial O Motor Vehicle
Property Address: O Products Liability (specify):
Other Negligence(specify):
NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner-
Other ProfessionalMalpractice (specify):
occupied residential property or owner-occupiedcondominium, complete and
O
attach the FORECLOSURERJIADDENDUM (UCS-840F). Declaratory judgment
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 Incorporaiius.,Z;..,,|st|or.
[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 06/10/2020
If yes, date filed:
Hasa summons and complaint or summonswith notice been served? O 07/27/2020
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=2tion
where indicated.
O Infant's Compromise
O Extreme Risk ProtectionOrder Application
O Note of Issue/Certificateof Readiness
O Date Issuejoined:
Notice of Medical, Dental, or Podiatric Malpractice
|udgment - Default
Relief Requested: Return Date:12/15/2020
Notice of Motion
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 Confarence
O ResidentialMortgage ForeclosureSettlement Conference
O Writ of HabeasCorpus
O Other (specify):
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FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020
NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 11/20/2020
RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space
is required, complete and attach the RJI Addendum (UCS-840A).
Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case
PARTIES: For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space
provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance
Un-
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; 3rd party plaintiff, etc.)email. been joined. carrier, if applicable.
Name: STATE FARM MUTUAL
☐ AUTOMOBILE INSURANCE
DAVID BOUCHER, RUBIN, FIORELLA, FRIEDMAN &
MERCANTE LLP, 630 Third Avenue, 3rd Floor , New York,
COMPANY NY 10017, 212-953-2381, dboucher@rubinfiorella.com ☐ YES ☒ NO
Role(s): Plaintiff/Petitioner
Name: NEW SENSE ACUPUNCTURE,
☒ P.C.
21974 A 64th Avenue, Bayside, NY 11364
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: RIU CHIROPRACTIC P.C.
☒ 255 East 98th Street, Brooklyn, NY 11212
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: CITIMEDICAL I, PLLC
☐ OLEG RYBAK, THE RYBAK FIRM PLLC, 1810 VOORHIES
AVENUE, SUITE 7 , Brooklyn, NY 11235, 718-975-2035, ☒ YES ☐ NO
Role(s): Defendant/Respondent orybak@rybakfirm.com
Name: LIDA PHYSICAL THERAPY &
☒ ACUPUNCTURE, PLLC
41-61 Kissena Boulevard, Suite 35, Flushing, NY 11355
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: MC PHYSICAL THERAPY, P.C.
☒ 75-10 Yellowstone Boulevard, Apartment 4F, Rego Park,
NY 11374 ☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: TRIBORO MEDICAL
☒ SERVICES, P.C.
39-10 Church Avenue, Brooklyn, NY 11204
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: HAPPY APPLE MEDICAL
☒ SERVICES, P.C.
22 Harbor Drive, Brooklyn, NY 11234
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: MALVINA DRUG CORP.
☒ 300 Hempstead Turnpike, West Hempstead, NY 11552
☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: LONGEVITY MEDICAL
☐ SUPPLY, INC.
OLEG RYBAK, THE RYBAK FIRM PLLC, 1810 VOORHIES
AVENUE, SUITE 7 , Brooklyn, NY 11235, 718-975-2035, ☒ YES ☐ NO
Role(s): Defendant/Respondent orybak@rybakfirm.com
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 FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS
ACTION OR PROCEEDING.
Dated: 11/20/2020 DAVID F BOUCHER
Signature
4889598 DAVID F BOUCHER
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 3
FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020
Caption
NYSCEF Rider
DOC. Sheet
NO. 43 RECEIVED NYSCEF: 11/20/2020
Plaintiff(s)/Petitioner(s)
VS.
NEW SENSE ACUPUNCTURE, P.C., RIU CHIROPRACTIC P.C., CITIMEDICAL I, PLLC, LIDA PHYSICAL THERAPY &
ACUPUNCTURE, PLLC, MC PHYSICAL THERAPY, P.C., TRIBORO MEDICAL SERVICES, P.C., HAPPY APPLE MEDICAL
SERVICES, P.C., MALVINA DRUG CORP., LONGEVITY MEDICAL SUPPLY, INC., JA PHYSICAL THERAPY, P.C., MILASIGN INC.,
SUMMIT MEDICAL SERVICES, P.C., DOS MANOS CHIROPRACTIC, P.C., CROSSTOWN CHIROPRACTIC, P.C., BROOKDALE
HOSPTIAL MEDICAL CENTER a/k/a BHMC HOSP., RAD SUPPLY, INC., NOURSEEN PT, P.C., CONTEMPORARY ORTHOPEDICS,
PLLC, CVS RX INC. d/b/a EXPRESS PHARMACY, ALP SUPPLY INC., ANJANI SINHA MEDICAL, P.C., NYEEQASC, LLC a/k/a
NORTH QUEENS SURGICAL CENTER, NEXTSTEP HEALING, INC., PROTECHMED, INC., RAD SUPPLY INC., UNICAST, INC.,
DANIEL MILLER Defendant(s)/Respondent(s)
3 of 3
Preview
FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020 NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 11/20/2020 "CS" REQUEST FOR JUDICIAL INTERVENTION (rev. unzwzusw New York ';üpic;-c COURT, COUNTY OF New York Index No: 154154/2020 Date Index Issued: 06/17/2020 For Court Use Only: CAI er t eet. IAS EntryDate STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Judge Assigned -against- Plaintiff's),met|t|oner(s) NEW SENSE ACUPUNCTURE, P.C.,RIU CHIROPRACTIC P.C.,CITIMEDICAL I, PLLC,LIDA PHYSICAL THERAPY & ACUPUNCTURE, PLLC, MC PHYSICAL THERAPY, P.C.,TRii30RO MEDICAL SERVICES, P.C.,HAPPY APPLE MEDICAL RJIFiled Date SERVICES, P.C.,MALVINA DRUG CORP., LONGEVITY MEDICAL SUPPLY, INC., JA PHYSICAL THERAPY, P.C.,MILASI... D±nd=nt(c),"espondent(s) COMMERCIAL MATRIMONIAL O Contested O BusinessEntity (includes corporations, pe-+nerchine LLCs,LLps,etC.) NOTE: If there are children under the age of 18, complete and attach the Contract MATRIMONIAL RJIAddendum (UCS-84OM). O Insurance(where insurance company is a party, except arbitration) . . For UncontestedMatnmonial actions, use the UncontestedDivorce RJi(UD-13). O UCC(includes sales and negotiable instruments) Other Commercial(specify): | TORTS NOTE: For CommercialDivision assignment requests pursuant to 22 NYCRR202.70(d), complete and attach the COMMERCIALDIVISION RJIADDENDUM (UCS-840C). Asbestos O Child Victims Act REAL FRGFERTY: Specify how many properties the application includes: O Condemnation Medical,Dental, or Podiatric Malpractice O O nacidential Mortgage Foreclosure(specify): O Commercial O Motor Vehicle Property Address: O Products Liability (specify): Other Negligence(specify): NOTE: For Mortgage Foreclosureactions involving a one to four-family, owner- Other ProfessionalMalpractice (specify): occupied residential property or owner-occupiedcondominium, complete and O attach the FORECLOSURERJIADDENDUM (UCS-840F). Declaratory judgment 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 Incorporaiius.,Z;..,,|st|or. [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 06/10/2020 If yes, date filed: Hasa summons and complaint or summonswith notice been served? O 07/27/2020 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=2tion where indicated. O Infant's Compromise O Extreme Risk ProtectionOrder Application O Note of Issue/Certificateof Readiness O Date Issuejoined: Notice of Medical, Dental, or Podiatric Malpractice |udgment - Default Relief Requested: Return Date:12/15/2020 Notice of Motion 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 Confarence O ResidentialMortgage ForeclosureSettlement Conference O Writ of HabeasCorpus O Other (specify): 1 of 3 FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020 NYSCEF DOC. NO. 43 RECEIVED NYSCEF: 11/20/2020 RELATED CASES: List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case PARTIES: For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Parties Attorneys and/or Unrepresented Litigants Issue Joined Insurance Un- 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; 3rd party plaintiff, etc.)email. been joined. carrier, if applicable. Name: STATE FARM MUTUAL ☐ AUTOMOBILE INSURANCE DAVID BOUCHER, RUBIN, FIORELLA, FRIEDMAN & MERCANTE LLP, 630 Third Avenue, 3rd Floor , New York, COMPANY NY 10017, 212-953-2381, dboucher@rubinfiorella.com ☐ YES ☒ NO Role(s): Plaintiff/Petitioner Name: NEW SENSE ACUPUNCTURE, ☒ P.C. 21974 A 64th Avenue, Bayside, NY 11364 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: RIU CHIROPRACTIC P.C. ☒ 255 East 98th Street, Brooklyn, NY 11212 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: CITIMEDICAL I, PLLC ☐ OLEG RYBAK, THE RYBAK FIRM PLLC, 1810 VOORHIES AVENUE, SUITE 7 , Brooklyn, NY 11235, 718-975-2035, ☒ YES ☐ NO Role(s): Defendant/Respondent orybak@rybakfirm.com Name: LIDA PHYSICAL THERAPY & ☒ ACUPUNCTURE, PLLC 41-61 Kissena Boulevard, Suite 35, Flushing, NY 11355 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: MC PHYSICAL THERAPY, P.C. ☒ 75-10 Yellowstone Boulevard, Apartment 4F, Rego Park, NY 11374 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: TRIBORO MEDICAL ☒ SERVICES, P.C. 39-10 Church Avenue, Brooklyn, NY 11204 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: HAPPY APPLE MEDICAL ☒ SERVICES, P.C. 22 Harbor Drive, Brooklyn, NY 11234 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: MALVINA DRUG CORP. ☒ 300 Hempstead Turnpike, West Hempstead, NY 11552 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: LONGEVITY MEDICAL ☐ SUPPLY, INC. OLEG RYBAK, THE RYBAK FIRM PLLC, 1810 VOORHIES AVENUE, SUITE 7 , Brooklyn, NY 11235, 718-975-2035, ☒ YES ☐ NO Role(s): Defendant/Respondent orybak@rybakfirm.com 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 FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: 11/20/2020 DAVID F BOUCHER Signature 4889598 DAVID F BOUCHER Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 3 FILED: NEW YORK COUNTY CLERK 11/20/2020 10:18 AM INDEX NO. 154154/2020 Caption NYSCEF Rider DOC. Sheet NO. 43 RECEIVED NYSCEF: 11/20/2020 Plaintiff(s)/Petitioner(s) VS. NEW SENSE ACUPUNCTURE, P.C., RIU CHIROPRACTIC P.C., CITIMEDICAL I, PLLC, LIDA PHYSICAL THERAPY & ACUPUNCTURE, PLLC, MC PHYSICAL THERAPY, P.C., TRIBORO MEDICAL SERVICES, P.C., HAPPY APPLE MEDICAL SERVICES, P.C., MALVINA DRUG CORP., LONGEVITY MEDICAL SUPPLY, INC., JA PHYSICAL THERAPY, P.C., MILASIGN INC., SUMMIT MEDICAL SERVICES, P.C., DOS MANOS CHIROPRACTIC, P.C., CROSSTOWN CHIROPRACTIC, P.C., BROOKDALE HOSPTIAL MEDICAL CENTER a/k/a BHMC HOSP., RAD SUPPLY, INC., NOURSEEN PT, P.C., CONTEMPORARY ORTHOPEDICS, PLLC, CVS RX INC. d/b/a EXPRESS PHARMACY, ALP SUPPLY INC., ANJANI SINHA MEDICAL, P.C., NYEEQASC, LLC a/k/a NORTH QUEENS SURGICAL CENTER, NEXTSTEP HEALING, INC., PROTECHMED, INC., RAD SUPPLY INC., UNICAST, INC., DANIEL MILLER Defendant(s)/Respondent(s) 3 of 3