Arizona Medical Board

9545 E. Doubletree Ranch Road Scottsdale, AZ 85258-5514

Telephone: 480- 551-2700 Fax: 480-551-2704
Website: www.azmd.gov



J anuary 28, 2013


Seth Alan Stabinsky, M.D.



Dear Dr. Stabinsky:

This will acknowledge receipt of your application for licensure to practice medicine in the State
of Arizona. I have reviewed your application. To complete the processing of your application, the
following documentation is still required:

1) Evidence of Name and Date of Birth (Copy of Passport or Birth Certificate)
2) Medical College Transcripts
3) NBME Exam Scores (available online at www.nbme.org)
4) Hospital Affiliations/Medical Employment verification from:
a) Tiburcio Vasquez Health Center
b) Livingston Medical Group
c) Planned Parenthood Mar Monte
d) Regional Medical Center

*Note: Information will be provided by FCVS if you are using their service

All documents must come from the primary source.

Please be advised final action cannot be taken until the required information is in your
application file. It is your responsibility to ensure that the Board receives all documentation.

Please be advised that if your application is not fully complete within one year from this date,
your application is deemed withdrawn.

Should your application be approved, you will be notified of the initial licensing fee due for
issuance of your license.


Sincerely,
Arizona Medical Board

400 Fuller Wiser Road, Suite 300, Euless, TX 76039
Tel: (817) 868-5000 Fax: (817) 868-5099
Federation Credentials Verification Service (FCVS)
Verification of Graduate Medical Education
Institution: Bronx Municipal Hospital Center

Specialty: Obstetrics and Gynecology

Address: Bronx, NY
Attention: Jacobi Medical Ctr - House Staff Office

Verification For:
Name: STABINSKY, SETH ALAN
DOB:
Individual's Name on Record (If different from above):
Specialty/Subspecialty: OB/GYN & Women's Health
Successfull y Completed?:
Successfull y Completed?:
Successfull y Completed?:
Yes
Accredited by: LCGME
From: 07/01/1987 To: 06/30/1988
In Progress No
RSC AOA ACGME
Internship
Residency
Fellowship
Research
Training Level: 1
(e.g., 1, 2, 3, etc.)
Training Level:
(e.g., 1, 2, 3, etc.)
Internship
Residency
Fellowship
Research
From: / / To: / /
Accredited by: ACGME AOA
Yes No In Progress
From: / / To: / /
Yes No In Progress
Accredited by: ACGME AOA
Training Level:
(e.g., 1, 2, 3, etc.)
Internship
Residency
Fellowship
Research
Report Incomplete
Training Levels (years)
separate from those that
were successfully
completed.
If the training level (year) is
currently in progress report
the expected completion
date in the "To" field.
Report Internships,
Residencies and
Fellowships separately.
Use one section per
Department/Specialty. If the
Department/Specialty is
rotating or transitional, please
provide a schedule of
rotations.
Important:
Program
Participation:
CFPC
RCPSC APPAP None of these
CFPC RSC
None of these APPAP RCPSC
LCGME
None of these APPAP RCPSC
LCGME CFPC RSC
Chief Residency
Chief Residency
Chief Residency
Specialty/Subspecialty:
Specialty/Subspecialty:
Yes No 1. Did this individual ever take a leave of absence or break from his/her training?
Yes No 2. Was this individual ever placed on probation? .
3. Was this individual ever disciplined or placed under investigation? .
4. Were any negative reports for behavioral reasons ever filed by instructors? .....
Yes No
Yes No
Please explain any " Yes" response from above:




5. Were any limitations or special requirements placed upon this individual because
of questions of academic incompetence, disciplinary problems or any other reason?
Check the correct response.
Omitted responses require
written explanation.
If necessary, you may
continue your explanation
on a separate sheet of
paper.
Yes No
Unusual
Circumstances:
no seal is available,
you must have this
form notarized.
E-Mail: ebanks@montefiore.org Tel: 718-430-4031 Fax: 718-430-2576
Affix your institutional
seal in this space. If
Signature: Erika H. Bank,MD
Title of Signatory : Program Director

Name: Erika H. Banks, MD
Date of Signature: _12/13/2012______
Certification:
Rev. 12/12/2012
FCVS ID: 262206 FID: 206111874 CODE: 117220
Affiliated
University: Albert Einstein College of Medicine/MMC

Completion of the following is certification that the information above is an accurate account of this individuals records and is true
and correct. The signature line must contain the original signature, or the electronic typed signature, of the program director
(M.D./D.O. onl y).
Certification:


Affix your institutional
seal in this space. If
no seal is available,
you must have this
form notarized