HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 GASTROENTEROLOGIST BROOKLYN 1083618607 AUERBACH PURNA CHANDRA PRASAD 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 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 (6/30/2017) 1 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 (6/30/2017) 2 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 (6/30/2017) 3 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 GARCIACARRASQUILLO 1457337388 GARSON REUBEN GASTROENTEROLOGIST NEW YORK 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 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 (6/30/2017) 4 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 1861452245 KHDAIR ADNAN GASTROENTEROLOGIST NEW YORK 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 (6/30/2017) 5 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 1770547630 LI MICHAEL GASTROENTEROLOGIST FLUSHING 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 (6/30/2017) 6 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 1700880168 MULROONEY STEPHEN GASTROENTEROLOGIST STATEN ISLAND 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 (6/30/2017) 7 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 1326085168 PERTSOVSKY YURIY GASTROENTEROLOGIST BROOKLYN 1790734093 PISCATELLI JAMES GASTROENTEROLOGIST WILLIAMSVILLE 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 (6/30/2017) 8 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 1215945738 SCHWARTZ JONATHAN GASTROENTEROLOGIST BRONX 1427030691 SCOYNI ROBERT GASTROENTEROLOGIST MIDDLETOWN 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 (6/30/2017) 9 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 1659570323 TSIRLIN YURIY GASTROENTEROLOGIST BROOKLYN 1255317343 TUOTI RAYMOND GASTROENTEROLOGIST WILLIAMSVILLE 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 (6/30/2017) 10 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 1477710564 XIE JIANLIN GASTROENTEROLOGIST ELMHURST 1053325647 YAO ALAN GASTROENTEROLOGIST FLUSHING 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 (6/30/2017) 11 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 1205817624 BAILEY JUAN INFECTIOUS DISEASE NEW YORK 1831419654 BAJWA RAJINDER INFECTIOUS DISEASE CHEEKTOWAGA 1376522003 BAKSHI SAROJ INFECTIOUS DISEASE BRONX 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 (6/30/2017) 12 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 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 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 (6/30/2017) 13 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 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 (6/30/2017) 14 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 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 (6/30/2017) 15 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 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 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 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 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 (6/30/2017) 16 HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY 1003815440 SMITH PHILIP INFECTIOUS DISEASE NEWBURGH 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 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 (6/30/2017) 17 HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST PRACTITIONER NPI 1134381437 1588844815 1093886830 1649295254 1972934503 1083780795 1649356619 1548333941 1659354611 1316258775 1841225026 1063703940 1841251980 1205099249 1992798003 1760696413 1003034398 1578705372 PRACTITIONER LAST NAME ABBATESSA ADAMS ANGERAME BACK BERNOCK BILENKIN BLANCHARD BRIOT BROWN BUTNER CABASSA CARTMILL CHAMBLISS CHASAN CHAUDHRY CHEZ CHIU CURBELO PRACTITIONER FIRST NAME LAURIE HELEN MARY EPHRAIM KATHLEEN LEONID KERRY LEWIS KAREN JENNA EDWIN KIMBERLY PAUL RACHEL RIAZ NANCY MISTY DOLORES SPECIALTY DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE DEMONSTRATED EXPERIENCE¹ CITY BUFFALO NEW YORK ROCHESTER KINGSTON BROOKLYN NEW YORK STATEN ISLAND SYRACUSE BUFFALO NEW YORK BERGENFIELD BRONX BRONX NEW YORK NEWBURGH BRONX YONKERS BRONX Date² 6/30/2018 3/31/2018 6/30/2018 3/31/2018 9/30/2017 3/31/2018 3/31/2018 12/31/2017 6/30/2018 3/31/2018 6/30/2018 9/30/2017 6/30/2018 6/30/2018 6/30/2018 3/31/2018 6/30/2018 3/31/2018 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 (6/30/2017) 18 HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME 1992083885 DAYANROSEMAN 1629270459 DEHAAN 1942299920 DELLOSSO 1487810636 DOUGLAS 1740394204 FANO 1437105566 FEDER 1528011103 FEFER 1811095375 FERRIS 1992772966 FISHER 1821210808 FOX 1528084324 GANDHI 1881861524 GIURLEO 1114220639 GOULD 1861770521 GOVER 1679915706 GYURA 1891701223 HO 1669545661 ISSACK PRACTITIONER FIRST NAME SPECIALTY CITY DAVID DEMONSTRATED EXPERIENCE¹ BRONX ELLIOT JOHN ORIN ALBERT MICHAEL HILLARY JOSE DAVID AKINOLA AARON VANI PATRICIA JACQUELINE MARY PHILIP JAMES JOSHUA DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ BROOKLYN NEW YORK NEW YORK JAMAICA YONKERS NEW YORK NEW YORK BRONX BRONX NEW YORK BRONX MINEOLA BRONX NEW YORK JAMAICA NEW YORK Date² 3/31/2018 6/30/2018 12/31/2017 3/31/2018 6/30/2018 6/30/2018 6/30/2018 6/30/2018 9/30/2017 6/30/2018 6/30/2018 6/30/2018 9/30/2017 6/30/2018 9/30/2017 3/31/2018 12/31/2017 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 (6/30/2017) 19 HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST PRACTITIONER NPI 1336205293 1962428904 1578521423 1508965336 1669462511 1972563005 1366527368 1790968360 1669536496 1598712754 1265838627 1952520603 1033290242 1750439485 1730265000 1124100318 1083876452 1104939891 PRACTITIONER LAST NAME JOSEPH KELLY KERR KOIZUMI KOZMINSKI LANGHORNE LITWIN LONDON MANCENIDO MARTINEZ MELCHIORRE MILANO MOHAMMAD MORRISON MOTAMED MURAYAMA NAGARAJA NAYEL PRACTITIONER FIRST NAME GERALDINE ROBERTA CHRISTINE CHRISTINA GEORGE MARTHA ALAIN KARYN MICHAEL ANTHONY MICHELLE DANIELLE SAJJAD ELLEN DAVID ROBERT AARATHI AMAR SPECIALTY DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE DEMONSTRATED EXPERIENCE¹ CITY NEW YORK BRONX PEEKSKILL BRONX UTICA BINGHAMTON BRONX BRONX ROCHESTER BUFFALO NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK KINGSTON ASTORIA Date² 9/30/2017 3/31/2018 6/30/2018 3/31/2018 12/31/2017 9/30/2017 6/30/2018 6/30/2018 6/30/2018 6/30/2018 9/30/2017 12/31/2017 3/31/2018 6/30/2018 3/31/2018 3/31/2018 6/30/2018 9/30/2017 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 (6/30/2017) 20 HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME 1013354919 1013025253 1902008832 1902976293 1659765212 1043537954 1407055734 1851370662 1467896480 1588745905 1566592962 1568750651 1932279866 1215197074 1023034287 1003994930 1649253675 1437417789 NEBO OLENDER ORTIZ-MORALES OSORIO OXNARD PENROSE PORTUESE PRITCHETT QUARESIMA RAMSEY ROSA ROSMAN SANTHANAM SCHERER SCHMIDTBERGER SHALEV SHAPIRA SHUKLA PRACTITIONER FIRST NAME CHINYERE SUSAN HILDA GEORGINA MORIAH SARAH THOMAS KEVIN MARK KELLY DANIEL SCOTT HEMA MATTHEW JAMES NOGA ILAN SHUCHIN SPECIALTY DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ CITY BRONX NEW YORK BRONX NEW YORK NEW YORK NEW YORK GLENS FALLS BRONX SOUTH GLENS FALLS POUGHKEEPSIE, AMENIA BRONX BINGHAMTON BRONX NEW YORK NEW YORK NEW YORK NEW YORK BRONX Date² 12/31/2017 6/30/2018 12/31/2017 6/30/2018 3/31/2018 3/31/2018 3/31/2018 9/30/2017 3/31/2018 6/30/2018 6/30/2018 12/31/2017 3/31/2018 6/30/2018 9/30/2017 6/30/2018 3/31/2018 9/30/2017 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 (6/30/2017) 21 HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST PRACTITIONER NPI 1902831431 1215157235 1518083336 1376885111 1316063027 1699713792 1912273905 1659471845 1447415302 1063661833 1396984118 1154486082 1801054093 PRACTITIONER LAST NAME SIGEL SLINGERLAND SOLOWAY STELLA TENORE UTER VU WALDMAN WELCH-PHILIP WEY WONG ZELLAN ZEWDE PRACTITIONER FIRST NAME KEITH DAVID IRENE JENNIFER PETER SAMUEL TRANG M. JUSTINE SHARON GINGER JORDAN JONATHAN MULUBRHAN SPECIALTY DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE1 DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ DEMONSTRATED EXPERIENCE¹ CITY NEW YORK SOUTH GLENS FALLS BRONX NEW YORK BRONX BROOKLN NEW YORK ITHACA PEEKSKILL BRONX BRONX BROOKLYN NEW YORK Date² 6/30/2018 9/30/2017 12/31/2017 3/31/2018 12/31/2017 6/30/2018 6/30/2018 3/31/2018 6/30/2018 9/30/2017 12/31/2017 6/30/2018 6/30/2018 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 (6/30/2017) 22 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 (6/30/2017) 23
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