HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

1

1144298613 ABDELSAYED GEORGE GASTROENTEROLOGIST STATEN ISLAND

1376565358 ABEMAYOR ELIE GASTROENTEROLOGIST MOUNT KISCO

1649472382 ABERGEL JEFFREY GASTROENTEROLOGIST STATEN ISLAND

1750375416 ABOUJAOUDE JOSEPH GASTROENTEROLOGIST STATEN ISLAND

1104059427 ABRAHAM BIJU GASTROENTEROLOGIST GARDEN CITY

1073570081 ADEONIGBAGBE OLUSEGUN GASTROENTEROLOGIST HOLLIS

1760477830 ADER MICHAEL GASTROENTEROLOGIST BRONX

1942448345 AGARWAL RITU GASTROENTEROLOGIST NEW YORK

1104898311 AHMAD JAWAD GASTROENTEROLOGIST NEW YORK

1821013442 ANAND SURYANARAYAN GASTROENTEROLOGIST BROOKLYN

1891732483 ARIF ASMA GASTROENTEROLOGIST TROY

1427062694 ARON JOSHUA GASTROENTEROLOGIST ELMHURST

1558398271 ARYA YASHPAL GASTROENTEROLOGIST BROOKLYN

1972619823 ASHKIN JEFFREY GASTROENTEROLOGIST BAY SHORE

1063439099 ATALLAH RAMI GASTROENTEROLOGIST BROOKLYN

1972578490 ATLURI PURNA CHANDRA PRASAD

GASTROENTEROLOGIST BROOKLYN

1083618607 AUERBACH MITCHELL GASTROENTEROLOGIST YONKERS

1831138361 AUGELLO SABINO GASTROENTEROLOGIST ASTORIA

1417141664 BADALOV NISON GASTROENTEROLOGIST BROOKLYN

1679543888 BADALOV ILYA GASTROENTEROLOGIST RENSSELAER

1124000310 BANK LESLIE GASTROENTEROLOGIST BINGHAMTON

1962432476 BANSAL MEENA GASTROENTEROLOGIST NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

2

1053396572 BASU PRITHWIJIT GASTROENTEROLOGIST NEW YORK

1225029242 BATASH STEVEN GASTROENTEROLOGIST REGO PARK

1457380594 BEN MATTHEW GASTROENTEROLOGIST ALBANY

1396739553 BERGASA NORA GASTROENTEROLOGIST BROOKLYN

1932169307 BERLIN IRINA GASTROENTEROLOGIST NEW YORK

1043221450 BERNSTEIN MICHAEL GASTROENTEROLOGIST BROOKLYN

1912078304 BERNSTEIN DAVID GASTROENTEROLOGIST MANHASSET

1912913542 BHARUCHA STEPHEN GASTROENTEROLOGIST BRONX

1083931075 BLACHMAN DANIEL GASTROENTEROLOGIST KINGSTON

1396833588 BLAISE MARIE-NIRVA GASTROENTEROLOGIST BRONX

1346233475 BLANK ANDREW GASTROENTEROLOGIST NEW YORK

1669422739 BLESKI JOHN GASTROENTEROLOGIST NEW PALTZ

1063497295 BODENHEIMER HENRY GASTROENTEROLOGIST NEW YORK

1215254602 BODIN ROXANA GASTROENTEROLOGIST HAWTHORNE

1164599627 BORCICH ANTHONY GASTROENTEROLOGIST RENSSELAER

1548456890 BRAHA JACK GASTROENTEROLOGIST BROOKLYN

1396781332 BRODSKY ALEXANDER GASTROENTEROLOGIST BROOKLYN

1487667713 BRODSKY NEIL GASTROENTEROLOGIST DOUGLASTON

1043323462 BROOMFIELD PAUL GASTROENTEROLOGIST BAY SHORE

1497747091 BUNIAK BORYS GASTROENTEROLOGIST LIVERPOOL

1386707933 BUNIM ARI GASTROENTEROLOGIST FLUSHING

1639121452 CALDERONE JOSEPH GASTROENTEROLOGIST ELMIRA

1881679736 CHAIT MAXWELL GASTROENTEROLOGIST HAWTHORNE

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

3

1225053523 CHAN SING GASTROENTEROLOGIST FLUSHING

1043287857 CHAN WALLEN GASTROENTEROLOGIST STATEN ISLAND

1649299686 CHANG CHARISSA GASTROENTEROLOGIST NEW YORK

1205831658 CHASE MICHAEL GASTROENTEROLOGIST GLENS FALLS

1770696197 CHATALLASH ROBERT GASTROENTEROLOGIST BAY SHORE

1851353908 CHAUDHRY PC ABDUL GASTROENTEROLOGIST WARSAW

1134101785 CHERPAK RICHARD GASTROENTEROLOGIST UTICA

1891886842 CHU DANNY GASTROENTEROLOGIST NEW YORK

1588755565 CHU MARK GASTROENTEROLOGIST NEW YORK

1942287792 CHUANG CHE-NAN GASTROENTEROLOGIST FLUSHING

1518967769 CHUSID BORIS GASTROENTEROLOGIST FRANKLIN LAKES

1134133218 CIMPONERIU DAN GASTROENTEROLOGIST ASTORIA

1427030980 CLAREY DEBORAH GASTROENTEROLOGIST RENSSELAER

1972504611 COHEN DAVID GASTROENTEROLOGIST SCHENECTADY

1538190822 COHEN JEROME GASTROENTEROLOGIST BINGHAMTON

1558321968 CULLIFORD ANDREA GASTROENTEROLOGIST NEW ROCHELLE

1114943768 CULPEPPER-MORGAN JOAN GASTROENTEROLOGIST EAST SETAUKET

1922055276 DAVIDOFF SAMUEL GASTROENTEROLOGIST FOREST HILLS

1003011982 DEEB LILIANE GASTROENTEROLOGIST STATEN ISLAND

1326040411 DEFRANCISCO JOHN GASTROENTEROLOGIST BURNT HILLS

1952342628 DESHMUKH MADHAV GASTROENTEROLOGIST LOCKPORT

1225056070 DIETERICH DOUGLAS GASTROENTEROLOGIST NEW YORK

1548231160 DISTLER PETER GASTROENTEROLOGIST NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

4

1952559965 DUBROVSKAYA VERONIKA GASTROENTEROLOGIST BROOKLYN

1750591616 DUDDEMPUDI ANUPAMA GASTROENTEROLOGIST NEW HYDE PARK

1942271010 DURZIEH JOSEPH GASTROENTEROLOGIST NEW YORK

1437318730 ELDARAWY WAEL GASTROENTEROLOGIST BROOKLYN

1336174143 ELLS PETER GASTROENTEROLOGIST ALBANY

1588661052 ERBER WILLIAM GASTROENTEROLOGIST BROOKLYN

1639165293 ESPOSITO STEPHEN GASTROENTEROLOGIST FLUSHING

1861467250 FARAG SHERIF GASTROENTEROLOGIST STATEN ISLAND

1992731616 FAYYAZ MOHAMMAD GASTROENTEROLOGIST WILLIAMSVILLE

1043257819 FEDI PAOLO GASTROENTEROLOGIST PLATTSBURGH

1720009194 FERRARA NEIL GASTROENTEROLOGIST GARDEN CITY

1114136967 FOX ALYSON GASTROENTEROLOGIST NEW YORK

1710963426 FRANCELLA ANDREW GASTROENTEROLOGIST WHITE PLAINS

1861589954 FRISSORA-RODEO CHRISTINE GASTROENTEROLOGIST NEW YORK

1376583492 GAGLIO PAUL GASTROENTEROLOGIST NEW YORK

1134201742 GARCIA-CARRASQUILLO

REUBEN GASTROENTEROLOGIST NEW YORK

1457337388 GARSON DAVID GASTROENTEROLOGIST WILLIAMSVILLE

1588605588 GENUTH LEWIS GASTROENTEROLOGIST BROOKLYN

1518980093 GOLDFISCHER ALAN GASTROENTEROLOGIST GOSHEN

1093866386 GORDIN INNA GASTROENTEROLOGIST WOODMERE

1902857303 GOTTESMAN DEMOCLEIA GASTROENTEROLOGIST BROOKLYN

1366460198 GREWAL PRIYA GASTROENTEROLOGIST NEW YORK

1851506869 GROSMAN IGOR GASTROENTEROLOGIST BROOKLYN

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

5

1821059668 GROSMAN IRWIN GASTROENTEROLOGIST NEW YORK

1013942085 GUTMAN JASON GASTROENTEROLOGIST ROCHESTER

1235279738 GUTWEIN JEREMY GASTROENTEROLOGIST BRONX

1053306480 GUTWEIN ISADORE GASTROENTEROLOGIST BRONX

1134170640 HASAN MUHAMMAD GASTROENTEROLOGIST WOODBURY

1548363559 HATHWAR JAGADEESH GASTROENTEROLOGIST SAYRE

1497922553 HELFT STEVEN GASTROENTEROLOGIST FISHKILL

1447210687 HERBSMAN NEIL GASTROENTEROLOGIST BRONX

1932137106 HERNANDEZ LINCOLN GASTROENTEROLOGIST NEW YORK

1154471993 HERTAN HILARY GASTROENTEROLOGIST YONKERS

1841268836 HOMER JOHN GASTROENTEROLOGIST PLATTSBURGH

1487711743 HUANG JONATHAN GASTROENTEROLOGIST ROCHESTER

1730497454 IM GENE GASTROENTEROLOGIST NEW YORK

1750315628 IONESCU GABRIEL GASTROENTEROLOGIST NEW YORK

1063650489 IQBAL INTIKHAB GASTROENTEROLOGIST SYRACUSE

1265506828 ISWARA KADIRAWELPILLAI GASTROENTEROLOGIST BROOKLYN

1629396445 IVANINA ELENA GASTROENTEROLOGIST NEW YORK

1649369554 IZQUIERDO THOMAS GASTROENTEROLOGIST JACKSON HEIGHTS

1154587731 JOHN SAVIO GASTROENTEROLOGIST SYRACUSE

1700817301 JOSEPH HELENA GASTROENTEROLOGIST HUNTINGTON

1578769303 KANNEGANTI KALYAN GASTROENTEROLOGIST BRONX

1841283546 KAUFMAN JOHN GASTROENTEROLOGIST FOREST HILLS

1538183678 KHAN AZEEM GASTROENTEROLOGIST FOREST HILLS

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

6

1861452245 KHDAIR ADNAN GASTROENTEROLOGIST NEW YORK

1124198569 KHODADADIAN EDNA GASTROENTEROLOGIST MANHASSET

1376655043 KHOKHAR ASIM GASTROENTEROLOGIST STONY BROOK

1548292139 KIMBALL ANNETTA GASTROENTEROLOGIST NEW YORK

1245346139 KIM-SCHLUGER HYUNG GASTROENTEROLOGIST NEW YORK

1932254695 KIYICI NEJAT GASTROENTEROLOGIST SCARSDALE

1538184239 KLION FRANKLIN GASTROENTEROLOGIST NEW YORK

1134283104 KLOTZ HENRY GASTROENTEROLOGIST LAWRENCE

1710979158 KODSI ROBERT GASTROENTEROLOGIST BROOKLYN

1508884842 KOHLROSER JAMES GASTROENTEROLOGIST BABYLON

1538327317 KORENFELD SVETLANA GASTROENTEROLOGIST WEST NYACK

1174589246 KORSAKOFF KRISTOPHER GASTROENTEROLOGIST WARWICK

1598758435 KOTLER DONALD GASTROENTEROLOGIST NEW YORK

1841395100 KUAN JACKSON GASTROENTEROLOGIST FLUSHING

1508079302 KUMBUM KAVITHA GASTROENTEROLOGIST BRONX

1053391482 LANGAN LAWRENCE GASTROENTEROLOGIST STATEN ISLAND

1770571135 LANTIN JOSE GASTROENTEROLOGIST YONKERS

1235390832 LAW LINDA GASTROENTEROLOGIST BROOKLYN

1619089513 LEBOVICS EDWARD GASTROENTEROLOGIST HAWTHORNE

1831249465 LEE YOUNG GASTROENTEROLOGIST LIVERPOOL

1568652261 LEE THOMAS GASTROENTEROLOGIST SYRACUSE

1265674998 LEONG JENNIFER GASTROENTEROLOGIST NEW YORK

1942285861 LESMAN ALAN GASTROENTEROLOGIST MELVILLE

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

7

1770547630 LI MICHAEL GASTROENTEROLOGIST FLUSHING

1437171683 LI JIANJUN GASTROENTEROLOGIST BROOKLYN

1487736054 LIDOFSKY STEVEN GASTROENTEROLOGIST BURLINGTON

1235390493 LIEBER LEAH GASTROENTEROLOGIST WESTBURY

1053341560 LIU LAWRENCE GASTROENTEROLOGIST NEW YORK

1508860107 LO WINSON GASTROENTEROLOGIST NEW CITY

1972589083 MAHESHWARI YOGESH GASTROENTEROLOGIST WILLIAMSVILLE

1356404529 MAIZEL BARRY GASTROENTEROLOGIST BROOKLYN

1306872155 MALIAKKAL BENEDICT GASTROENTEROLOGIST ROCHESTER

1083685994 MANCINO LAWRENCE GASTROENTEROLOGIST STATEN ISLAND

1003848854 MANSOUR MOHAMED GASTROENTEROLOGIST BAYSIDE

1104827138 MARHABA ALI GASTROENTEROLOGIST NORWICH

1376622183 MARSH FRANKLIN GASTROENTEROLOGIST EAST SYRACUSE

1649436163 MEHTA NILESH GASTROENTEROLOGIST MANHASSET

1053371005 MEHTA ASIT GASTROENTEROLOGIST MELVILLE

1134335946 MEHTA PREETI GASTROENTEROLOGIST MANHASSET

1396720256 MIN ALBERT GASTROENTEROLOGIST NEW YORK

1841498714 MINANO CECILIA GASTROENTEROLOGIST MIDDLETOWN

1396724357 MIQDADI JEHAD GASTROENTEROLOGIST WILLIAMSVILLE

1730173857 MIRZA AAMER GASTROENTEROLOGIST NEW HARTFORD

1922160472 MOHANTY SMRUTI GASTROENTEROLOGIST SHREWSBURY

1700957727 MOORE MICHAEL GASTROENTEROLOGIST WEST SENECA

1528012259 MOSHENYAT YITZCHAK GASTROENTEROLOGIST BROOKLYN

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

8

1700880168 MULROONEY STEPHEN GASTROENTEROLOGIST STATEN ISLAND

1053534578 MUSLIM ARIF GASTROENTEROLOGIST NEW WINDSOR

1285693820 MUSTACCHIA PAUL GASTROENTEROLOGIST NEW YORK

1265598759 MYUNG JOON GASTROENTEROLOGIST FLUSHING

1972522936 NADAF ALBERT GASTROENTEROLOGIST BROOKLYN

1053598227 NAIK JAHNAVI GASTROENTEROLOGIST NEW YORK

1174732663 NARASIMHAN GOPAL GASTROENTEROLOGIST NEW YORK

1457531873 NARENDRA NITHAN GASTROENTEROLOGIST BRONX

1932519097 NGUYEN ANDREW GASTROENTEROLOGIST NEW YORK

1235191685 NIA KAMRAN GASTROENTEROLOGIST FOREST HILLS

1750606711 NICI ANTHONY GASTROENTEROLOGIST MIDDLETOWN

1154375087 NIZAM RAYEES GASTROENTEROLOGIST SYRACUSE

1447256508 OBADIAH BARRY GASTROENTEROLOGIST ASTORIA

1124058631 ODIN JOSEPH GASTROENTEROLOGIST NEW YORK

1427246628 OLOWE KAYODE GASTROENTEROLOGIST BRONX

1124221882 OLSEN SONJA GASTROENTEROLOGIST NEW YORK

1497797708 PADDU PADMANABH GASTROENTEROLOGIST WOODSIDE

1427062108 PAN CALVIN GASTROENTEROLOGIST ELMHURST

1073713772 PARK JAMES GASTROENTEROLOGIST NEW YORK

1396735874 PARMAR KIRANPREET GASTROENTEROLOGIST STATEN ISLAND

1588721658 PATEL SUNIL GASTROENTEROLOGIST METUCHEN

1902845761 PATEL DHIREN GASTROENTEROLOGIST MIDDLETOWN

1316912207 PELLEGRINI RICHARD GASTROENTEROLOGIST HEMPSTEAD

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

9

1326085168 PERTSOVSKY YURIY GASTROENTEROLOGIST BROOKLYN

1790734093 PISCATELLI JAMES GASTROENTEROLOGIST WILLIAMSVILLE

1841291697 PODESZWA JOHN GASTROENTEROLOGIST MIDDLETOWN

1396847976 POU RICARDO GASTROENTEROLOGIST NEW YORK

1508897042 PULEO JAMES GASTROENTEROLOGIST ALBANY

1134230873 PURCELL PETER GASTROENTEROLOGIST SCHENECTADY

1306934807 PUROW ELIAS GASTROENTEROLOGIST STATEN ISLAND

1376561233 PUROW DAVID GASTROENTEROLOGIST HUNTINGTON

1457514044 RAHMANI RABIN GASTROENTEROLOGIST BROOKLYN

1285698209 RAMANI KAMINI GASTROENTEROLOGIST GLOVERSVILLE

1801822846 RAMARAJU GOPAL GASTROENTEROLOGIST ROCHESTER

1851336366 RAWLINS SEKOU GASTROENTEROLOGIST SYRACUSE

1669557435 REINUS JOHN GASTROENTEROLOGIST BRONX

1902999287 RENVOIZE GUY GASTROENTEROLOGIST BRONX

1043239387 RIEDERS BRADLEY GASTROENTEROLOGIST VALLEY STREAM

1952360968 RIZVON KALEEM GASTROENTEROLOGIST EAST MEADOW

1720072846 ROMANO THOMAS GASTROENTEROLOGIST LIVERPOOL

1902907892 RUSSELL SAMUEL GASTROENTEROLOGIST EAST SYRACUSE

1487649554 SABLE ROBERT GASTROENTEROLOGIST BRONX

1164457495 SALVATORE LIBERATO GASTROENTEROLOGIST BAYSIDE

1447207428 SAYAD KARIM GASTROENTEROLOGIST BROOKLYN

1184802274 SAYEDY LEENA GASTROENTEROLOGIST ELMIRA

1689604191 SCHIANO THOMAS GASTROENTEROLOGIST NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

10

1215945738 SCHWARTZ JONATHAN GASTROENTEROLOGIST BRONX

1427030691 SCOYNI ROBERT GASTROENTEROLOGIST MIDDLETOWN

1063481778 SHAHIDULLAH ABUL GASTROENTEROLOGIST RIDGEWOOD

1952325599 SHAPSIS ALEXANDER GASTROENTEROLOGIST BROOKLYN

1760466254 SHARMA ANIL GASTROENTEROLOGIST ROCHESTER

1003913682 SIDERIDIS KOSTAS GASTROENTEROLOGIST SYOSSET

1457448540 SIGAL SAMUEL GASTROENTEROLOGIST NEW YORK

1184714925 SIMON DOUGLAS GASTROENTEROLOGIST BRONX

1003899261 SKLAR BRADLEY GASTROENTEROLOGIST UTICA

1568457653 SOMNAY KAUMUDI GASTROENTEROLOGIST FLUSHING

1093941205 SONG XIAOSONG GASTROENTEROLOGIST POTSDAM

1164554622 SPIELBERG ALAN GASTROENTEROLOGIST SMITHTOWN

1821029026 STAMBLER JAY GASTROENTEROLOGIST EAST ISLIP

1285620237 STEIN DAVID GASTROENTEROLOGIST BRONX

1447316104 SUK CHANG HO GASTROENTEROLOGIST FLUSHING

1932121456 SURLA GEORGE GASTROENTEROLOGIST ASTORIA

1942299771 SYAM BISWARUP GASTROENTEROLOGIST EAST SYRACUSE

1366528523 SYED ZAINUL-ABIDEEN GASTROENTEROLOGIST SCHENECTADY

1063502235 TALAL ANDREW GASTROENTEROLOGIST BUFFALO

1750398566 TENNER SCOTT GASTROENTEROLOGIST BROOKLYN

1144212853 THANTAFILLORE NICHOLAS GASTROENTEROLOGIST JAMAICA

1720001043 TIFFT JAMES GASTROENTEROLOGIST SYRACUSE

1629261722 TIN HUI HING GASTROENTEROLOGIST BROOKLYN

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

11

1659570323 TSIRLIN YURIY GASTROENTEROLOGIST BROOKLYN

1255317343 TUOTI RAYMOND GASTROENTEROLOGIST WILLIAMSVILLE

1003042672 VADADA DEEPAK GASTROENTEROLOGIST STATEN ISLAND

1639268105 VAIZMAN KONSTANTIN GASTROENTEROLOGIST BROOKLYN

1639267107 VATRA BOGDAN GASTROENTEROLOGIST CORTLAND

1699779298 VELA JAMES GASTROENTEROLOGIST NEW CITY

1518965250 VLODOV-LEVITT JANE GASTROENTEROLOGIST BROOKLYN

1578683157 VOZICK JESSE GASTROENTEROLOGIST NEW YORK

1982872008 WANG LAN GASTROENTEROLOGIST NEW YORK

1124286034 WANG CHUANSHENG GASTROENTEROLOGIST NEW YORK

1023154069 WASSERMAN DANIEL GASTROENTEROLOGIST FOREST HILLS

1831193457 WAYNE PETER GASTROENTEROLOGIST YONKERS

1083661904 WEINER FRANCIS GASTROENTEROLOGIST SCARSDALE

1265423081 WEINSTEIN GERALD GASTROENTEROLOGIST WATERTOWN

1417117060 WEISBERG ILAN GASTROENTEROLOGIST NEW YORK

1922083880 WEISSMAN SAM GASTROENTEROLOGIST CEDARHURST

1477501849 WERTH THOMAS GASTROENTEROLOGIST ROCHESTER

1326019944 WEST CARL GASTROENTEROLOGIST ITHACA

1821162173 WILLIAMS SUSAN GASTROENTEROLOGIST NEW YORK

1801998950 WOLF DAVID GASTROENTEROLOGIST VALHALLA

1861596041 WOLFSON DAVID GASTROENTEROLOGIST BROOKLYN

1790759298 WONG CHUN GASTROENTEROLOGIST NEW YORK

1598966301 XIAO PEIYING GASTROENTEROLOGIST BROOKLYN

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

12

1477710564 XIE JIANLIN GASTROENTEROLOGIST ELMHURST

1053325647 YAO ALAN GASTROENTEROLOGIST FLUSHING

1689679029 YARZE JOSEPH GASTROENTEROLOGIST GLENS FALLS

1740233253 YIO XIANYANG GASTROENTEROLOGIST GREAT NECK

1841369360 ZHAO XINYU GASTROENTEROLOGIST ELMHURST

1063412609 ZIMBALIST ELIOT GASTROENTEROLOGIST BROOKLYN

1619908217 ZINKIN NOAH GASTROENTEROLOGIST HUNTINGTON

1821189804 ZLATANIC JUSUF GASTROENTEROLOGIST NEW YORK

1396782629 BROWN ROBERT HEPATOLOGY NEW YORK

1376583930 DOVE LORNA HEPATOLOGY NEW YORK

1518136860 KALIA HARMIT HEPATOLOGY BRONX

1508936659 LEE TAI-PING HEPATOLOGY MANHASSET

1356308738 MALET PETER HEPATOLOGY MINEOLA

1639156318 STEHLIN MURIEL HEPATOLOGY EAST SETAUKET

1306291802 WOODS CHRISTOPHER HEPATOLOGY NEW YORK

1285621698 ADEDEJI ADEDAYO INFECTIOUS DISEASE STATEN ISLAND

1376625905 AFACAN YUSUF INFECTIOUS DISEASE BROOKLYN

1316259419 AKIYAMA MATTHEW INFECTIOUS DISEASE BRONX

1780698936 ALONSO GEORGE INFECTIOUS DISEASE ELMHURST

1104916907 ALPERT PETER INFECTIOUS DISEASE BRONX

1386745883 ANTONIOS VERA INFECTIOUS DISEASE BRONX

1437317658 ASIAGO-REDDY ELIZABETH INFECTIOUS DISEASE SYRACUSE

1295704963 BADEM OLGA INFECTIOUS DISEASE NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

13

1205817624 BAILEY JUAN INFECTIOUS DISEASE NEW YORK

1831419654 BAJWA RAJINDER INFECTIOUS DISEASE CHEEKTOWAGA

1376522003 BAKSHI SAROJ INFECTIOUS DISEASE BRONX

1467730945 BENRATH MICHELLE INFECTIOUS DISEASE BRONX

1881761245 BERKEY PETER INFECTIOUS DISEASE YONKERS

1265534564 BERKOWITZ LEONARD INFECTIOUS DISEASE EAST SYRACUSE

1487683736 BLAIR DONALD INFECTIOUS DISEASE SYRACUSE

1548288277 BORREGO FERNANDO INFECTIOUS DISEASE NEW YORK

1396712113 BOTTLER ANJA INFECTIOUS DISEASE ROCHESTER

1760425458 BRUTUS ANDRE INFECTIOUS DISEASE BROOKLYN

1669679494 CARMODY ELLIE INFECTIOUS DISEASE NEW YORK

1942399837 CINDRICH RICHARD INFECTIOUS DISEASE BRONX

1912171430 CLOONAN SEAN INFECTIOUS DISEASE NEW YORK

1457357378 CORALES ROBERTO INFECTIOUS DISEASE ROCHESTER

1720018674 CREVECOEUR HARRY INFECTIOUS DISEASE BROOKLYN

1336183375 CRONEY CHERYL INFECTIOUS DISEASE BROOKLYN

1871656215 DALLAPIAZZA MICHELLE INFECTIOUS DISEASE NEW YORK

1952463937 DASKALAKIS DEMETRE INFECTIOUS DISEASE NEW YORK

1306973755 DIERBERG KERRY INFECTIOUS DISEASE NEW YORK

1023116662 DONAGHY HENRY INFECTIOUS DISEASE MANHASSET

1518234640 DOYLE JENNY INFECTIOUS DISEASE MANHASSET

1700835337 DUAH MARYLENE INFECTIOUS DISEASE WATERTOWN

1912173212 ECKHARDT BENJAMIN INFECTIOUS DISEASE NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

14

1134228208 EDLIN BRIAN INFECTIOUS DISEASE NEW YORK

1659311439 EL DAHER NAYEF INFECTIOUS DISEASE ROCHESTER

1497815559 EPSTEIN MARCIA INFECTIOUS DISEASE MANHASSET

1912227125 EVANS TYLER INFECTIOUS DISEASE BRONX

1285861930 FEINSTEIN ADDI INFECTIOUS DISEASE BRONX

1649298472 FIERER DANIEL INFECTIOUS DISEASE NEW YORK

1780682351 FINE STEVEN INFECTIOUS DISEASE ROCHESTER

1013909167 FISH DOUGLAS INFECTOUS DISEASE ALBANY

1437356789 GARGAN JOHN INFECTIOUS DISEASE NEW YORK

1841596103 GAUTAM-GOYAL PRANISHA INFECTIOUS DISEASE MANHASSET

1730124033 GILROY SHELLEY INFECTIOUS DISEASE ALBANY

1568463545 GO EDDIE INFECTIOUS DISEASE ARVERNE

1053392472 GOMEZ TESSA INFECTIOUS DISEASE NEW YORK

1407872211 GONZALEZ EFRAIN INFECTIOUS DISEASE BRONX

1083697155 GOOD GARY INFECTIOUS DISEASE MONTICELLO

1063510857 GUPTA JYOTI INFECTIOUS DISEASE NEW YORK

1194893461 HARIAHARAN, MD RADHIKA INFECTIOUS DISEASE YONKERS

1063657252 HAYES LISA INFECTIOUS DISEASE MANHASSET

1518288950 HELBIG SINA INFECTIOUS DISEASE RENSSELAER

1073505723 HERMAN DAVID INFECTIOUS DISEASE ALBANY

1801827035 HERMOGENES ALICIA INFECTIOUS DISEASE CHEEKTOWAGA

1578533394 HIRSCH BRUCE INFECTIOUS DISEASE MANHASSET

1205806023 HIRSCHWERK DAVID INFECTIOUS DISEASE MANHASSET

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

15

1134148489 HOOVER KAREN INFECTIOUS DISEASE NEW YORK

1336344241 JEBRAEILI JOHARI FATIMA INFECTIOUS DISEASE NEW YORK

1730260811 JENNY-AVITAL ELIZABETH INFECTIOUS DISEASE BRONX

1356474662 JOHNSON LIVETTE INFECTIOUS DISEASE NEW YORK

1225293301 JOSEPH GILIANE INFECTIOUS DISEASE BRONX

1861698490 KANG SEUNG HEE INFECTIOUS DISEASE NEW YORK

1740573468 KAPLAN-LEWIS EMMA INFECTIOUS DISEASE NEW YORK

1033199294 KIM ANGELA INFECTIOUS DISEASE MANHASSET

1447340245 KLEIN ROBERT INFECTIOUS DISEASE BRIARCLIFF MANOR

1043295926 KOSHY SANJANA INFECTIOUS DISEASE NEW YORK

1831427137 KOSHY ROBIN INFECTIOUS DISEASE MANHASSET

1063464519 KUTLER CHARLES INFECTIOUS DISEASE KINGSTON

1700888013 LANDMAN DAVID INFECTIOUS DISEASE BROOKLYN

1043372022 LEE GREGORY INFECTIOUS DISEASE NEW YORK

1073672762 LENOX THEODORE INFECTIOUS DISEASE NEW YORK

1134107774 LIPSKY WILLIAM INFECTIOUS DISEASE LONG BEACH

1811089972 LUGO LUZ INFECTIOUS DISEASE NEW YORK

1487720017 MAJE HAFIZ INFECTIOUS DISEASE NEW YORK

1871556316 MALHOTRA PRASHANT INFECTIOUS DISEASE MANHASSET

1548466022 MALVESTUTTO CARLOS INFECTIOUS DISEASE NEW YORK

1255421426 MARKS KRISTEN INFECTIOUS DISEASE NEW YORK

1295053072 MATTA MANDEEP INFECTIOUS DISEASE ALBANY

1689654840 MCGOWAN JOSEPH INFECTIOUS DISEASE MANHASSET

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

16

1821028051 MCMEEKING ALEXANDER INFECTIOUS DISEASE NEW YORK

1750375374 MILLER CYNTHIA INFECTIOUS DISEASE ALBANY

1942381405 MORA-MCLAUGHLIN FERNANDO INFECTIOUS DISEASE BRONX

1770760084 NORTON BRIANA INFECTIOUS DISEASE BRONX

1174847107 NG MICHEL INFECTIOUS DISEASE NEW YORK

1477729077 PATEL MARISH INFECTIOUS DISEASE BRONX

1558387431 PAUL JOSEPH INFECTIOUS DISEASE BROOKLYN

1235110651 PERLMAN DAVID INFECTIOUS DISEASE NEW YORK

1386671717 PERRY RUSSELL INFECTIOUS DISEASE NEW YORK

1700985199 PHAM VINH INFECTIOUS DISEASE NEW YORK

1346238912 POLLACK HENRY INFECTIOUS DISEASE NEW YORK

1912917816 PSEVDOS GEORGE INFECTIOUS DISEASE NEW YORK

1997999122 PUNJ SONIA INFECTIOUS DISEASE JAMAICA

1023003332 QUALE JOHN INFECTIOUS DISEASE BROOKLYN

1932214467 QUINTANILLA JULIO INFECTIOUS DISEASE BRONX

1366519910 RADIX ASA INFECTIOUS DISEASE NEW YORK

1982638060 RAMANI ANANTHAKRISHNAN INFECTIOUS DISEASE HUDSON

1831351212 REBICK GABRIEL INFECTIOUS DISEASE BROOKLYN

1396816393 RESTRIEPO DALILAH INFECTIOUS DISEASE JAMAICA

1760628820 REVERE ELIZABETH INFECTIOUS DISEASE MANHASSET

1295706497 RUSH THOMAS INFECTIOUS DISEASE BRIARCLIFF MANOR

1174505275 SALOMON NADIM INFECTIOUS DISEASE NEW YORK

1861653198 SARPEL DOST INFECTIOUS DISEASE NEW YORK

HEPATITIS C MEDICAID PRACTITIONER LIST

PRACTITIONER

NPI

PRACTITIONER

LAST NAME

PRACTITIONER

FIRST NAME SPECIALTY CITY

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

Last Updated (3/31/2018)

17

1316928468 SEGAL BRAHM INFECTIOUS DISEASE QUEENSBURY

1114997921 SHAH SANJIV INFECTIOUS DISEASE MANHASSET

1285807628 SIEGEL LAWRENCE INFECTIOUS DISEASE NEW YORK

1396780375 SKELLY MICHAEL INFECTIOUS DISEASE BRONX

1558520445 SLOSAR MAGDALENA INFECTIOUS DISEASE YONKERS

1003815440 SMITH PHILIP INFECTIOUS DISEASE NEWBURGH

1790224822 SPIER DANIEL INFECTIOUS DISEASE NEW YORK

1831145648 STEIN ALAN INFECTIOUS DISEASE BROOKLYN

1750565834 STIVALA ALICIA INFECTIOUS DISEASE NEW YORK

1922036987 STRATIDIS JOHN INFECTIOUS DISEASE DANBURY

1457582868 SUMMERS REBECCA INFECTIOUS DISEASE BROOKLYN

1982781068 TANG IAN INFECTIOUS DISEASE NEW YORK

1477511673 WALDRON MARY INFECTIOUS DISEASE NEW YORK

1497817480 ARNON RONEN TRANSPLANT SURGERY NEW YORK

1821084211 MORGAN GLYN TRANSPLANT SURGERY NEW YORK

HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST

PRACTITIONER NPI

PRACTITIONER LAST NAME

PRACTITIONER FIRST NAME SPECIALTY CITY Date²

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months

and at least 10 HCV- related CME credits in the last 12 months.

² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.

(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)

18

1134381437 ABBATESSA LAURIE DEMONSTRATED EXPERIENCE¹ BUFFALO 6/30/2018

1093886830 ANGERAME MARY DEMONSTRATED EXPERIENCE¹ ROCHESTER 6/30/2018

1649295254 BACK EPHRAIM DEMONSTRATED EXPERIENCE1 KINGSTON 3/31/2019

1972934503 BERNOCK KATHLEEN DEMONSTRATED EXPERIENCE1 BROOKLYN 12/30/2018

1083780795 BILENKIN LEONID DEMONSTRATED EXPERIENCE¹ NEW YORK 3/31/2019

1649356619 BLANCHARD KERRY DEMONSTRATED EXPERIENCE¹ STATEN ISLAND 3/31/2019

1659354611 BROWN KAREN DEMONSTRATED EXPERIENCE¹ BUFFALO 6/30/2018

1841225026 CABASSA EDWIN DEMONSTRATED EXPERIENCE¹ BERGENFIELD 6/30/2018

1063703940 CARTMILL KIMBERLY DEMONSTRATED EXPERIENCE¹ BRONX 3/31/2019

1841251980 CHAMBLISS PAUL DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1205099249 CHASAN RACHEL DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1992798003 CHAUDHRY RIAZ DEMONSTRATED EXPERIENCE¹ NEWBURGH 6/30/2018

1760696413 CHEZ NANCY DEMONSTRATED EXPERIENCE¹ BRONX 3/31/2019

1003034398 CHIU MISTY DEMONSTRATED EXPERIENCE YONKERS 6/30/2018

1629270459 DEHAAN ELLIOT DEMONSTRATED EXPERIENCE¹ BROOKLYN 6/30/2018

1740394204 FANO MICHAEL DEMONSTRATED EXPERIENCE¹ JAMAICA 6/30/2018

1437105566 FEDER HILLARY DEMONSTRATED EXPERIENCE¹ YONKERS 6/30/2018

1528011103 FEFER JOSE DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST

PRACTITIONER NPI

PRACTITIONER LAST NAME

PRACTITIONER FIRST NAME SPECIALTY CITY Date²

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months

and at least 10 HCV- related CME credits in the last 12 months.

² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.

(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)

19

1811095375 FERRIS DAVID DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1992772966 FISHER AKINOLA DEMONSTRATED EXPERIENCE¹ BRONX 9/30/2018

1821210808 FOX AARON DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1528084324 GANDHI VANI DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1881861524 GIURLEO PATRICIA DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1861770521 GOVER MARY DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1801805759 GRIFFIN EVE DEMONSTRATED EXPERIENCE¹ BRENTWOOD 9/30/2018

1154677854 GRISALES DIEGO DEMONSTRATED EXPERIENCE¹ ROCHESTER 9/30/2018

1306212311 HILL ERICA DEMONSTRATED EXPERIENCE¹ BINGHAMTON 9/30/2018

1669545661 ISSACK JOSHUA DEMONSTRATED EXPERIENCE¹ NEW YORK 12/30/2018

1336205293 JOSEPH GERALDINE DEMONSTRATED EXPERIENCE¹ NEW YORK 9/30/2018

1427343722 KANAHARA SATOKO DEMONSTRATED EXPERIENCE¹ BRONX 3/31/2019

1962428904 KELLY ROBERTA DEMONSTRATED EXPERIENCE¹ BRONX 3/31/2019

1578521423 KERR CHRISTINE DEMONSTRATED EXPERIENCE¹ PEEKSKILL 6/30/2018

1407239635 KIEFER CLAIRE DEMONSTRATED EXPERIENCE¹ BROOKLYN 12/30/2018

1669462511 KOZMINSKI GEORGE DEMONSTRATED EXPERIENCE¹ UTICA 12/30/2018

1366527368 LITWIN ALAIN DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1790968360 LONDON KARYN DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST

PRACTITIONER NPI

PRACTITIONER LAST NAME

PRACTITIONER FIRST NAME SPECIALTY CITY Date²

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months

and at least 10 HCV- related CME credits in the last 12 months.

² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.

(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)

20

1669536496 MANCENIDO MICHAEL DEMONSTRATED EXPERIENCE¹ ROCHESTER 6/30/2018

1598712754 MARTINEZ ANTHONY DEMONSTRATED EXPERIENCE¹ BUFFALO 6/30/2018

1265838627 MELCHIORRE MICHELLE DEMONSTRATED EXPERIENCE¹ NEW YORK 9/30/2018

1952520603 MILANO DANIELLE DEMONSTRATED EXPERIENCE¹ NEW YORK 12/30/2018

1750439485 MORRISON ELLEN DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1083876452 NAGARAJA AARATHI DEMONSTRATED EXPERIENCE KINGSTON 6/30/2018

1013354919 NEBO CHINYERE DEMONSTRATED EXPERIENCE¹ BRONX 12/30/2018

1932528197 NOCERINO ANGELICA DEMONSTRATED EXPERIENCE¹ NEW YORK 3/31/2019

1013025253 OLENDER SUSAN DEMONSTRATED EXPERIENCE NEW YORK 6/30/2018

1902976293 OSORIO GEORGINA DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1407055734 PORTUESE THOMAS DEMONSTRATED EXPERIENCE1 GLENS FALLS 3/31/2019

1851370662 PRITCHETT KEVIN DEMONSTRATED EXPERIENCE¹ BRONX 9/30/2018

1467896480 QUARESIMA MARK DEMONSTRATED EXPERIENCE1 SOUTH GLENS FALLS 3/31/2019

1588745905 RAMSEY KELLY DEMONSTRATED EXPERIENCE¹ POUGHKEEPSIE, AMENIA 6/30/2018

1566592962 ROSA DANIEL DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018

1568750651 ROSMAN SCOTT DEMONSTRATED EXPERIENCE¹ BINGHAMTON 12/30/2018

1215197074 SCHERER MATTHEW DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1003994930 SHALEV NOGA DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST

PRACTITIONER NPI

PRACTITIONER LAST NAME

PRACTITIONER FIRST NAME SPECIALTY CITY Date²

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months

and at least 10 HCV- related CME credits in the last 12 months.

² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.

(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)

21

1902831431 SIGEL KEITH DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1215157235 SLINGERLAND DAVID DEMONSTRATED EXPERIENCE¹ SOUTH GLENS FALLS 9/30/2018

1518083336 SOLOWAY IRENE DEMONSTRATED EXPERIENCE¹ BRONX 12/30/2018

1316063027 TENORE PETER DEMONSTRATED EXPERIENCE¹ BRONX 12/30/2018

1699713792 UTER SAMUEL DEMONSTRATED EXPERIENCE¹ BROOKLN 6/30/2018

1912273905 VU TRANG M. DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

1659471845 WALDMAN JUSTINE DEMONSTRATED EXPERIENCE1 ITHACA 3/31/2019

1447415302 WELCH-PHILIP SHARON DEMONSTRATED EXPERIENCE¹ PEEKSKILL 6/30/2018

1063661833 WEY GINGER DEMONSTRATED EXPERIENCE¹ BRONX 9/30/2018

1184652067 WILDFEUER OLGA DEMONSTRATED EXPERIENCE¹ NEW YORK 3/31/2019

1154486082 ZELLAN JONATHAN DEMONSTRATED EXPERIENCE¹ BROOKLYN 6/30/2018

1801054093 ZEWDE MULUBRHAN DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018

HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST

PRACTITIONER NPI

PRACTITIONER LAST NAME

PRACTITIONER FIRST NAME SPECIALTY CITY Date²

Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.

¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months

and at least 10 HCV- related CME credits in the last 12 months.

² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.

(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)

22