The Official Web Site For The State of New Jersey - Department of Treasury

Consolidated Debarment Search Results

Your search generated 3614 matches.

NOTE: These search results first display individuals without a firm name followed by firms, with and without individuals named, alphabetically. Be sure to review the full list of matches. Results may also include one or more listings for a single individual and/or associated firms.

To refine the search results, use your browser Back button and revise your search criteria.

NOTE: For more information about an individual debarment/suspension action, contact the agency listed in the "Action/by" field. Agency contact information can be found on their website.

This data was last updated on 6/9/2021.

Firm and/or Individual Category/Reason Action/By Effective Expiration
ABARCA, CHERYL R. (LPN)
528 3RD STREET
NEWARK, NJ 07107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
ABASHKIN, ROMAN (CHHA)
72 RIDGEVIEW TERRACE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/29/2015
ABASHKIN, ROMAN (CHHA)
72 RIDGEVIEW TERRACE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
ABBASSI, JADAN (MD)
1618 MAIN AVENUE
CLIFTON, NJ 07011

NPI-1194807255
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016 Permanent
ABBASSI, JADAN (MD)
115 NELLIS DRIVE
WAYNE, NJ 07470

NPI-1194807255
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018 Permanent
EMPIRE STATE MED. SVC INC
1116 ANNE STREET
ELIZABETH, NJ 07201

ABDALLA, IZZELDIN
1116 ANNE STREET
ELIZABETH, NJ 07201

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/10/1999 Permanent
ABDELGANI, AMIR
ALLENWOOD USP
WHITE DEER, PA 17887

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/26/2001
ABDELGANI, FADIL
TERRE HAUTE USP
TERRE HAUTE, IN 47808

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/26/2001 Permanent
ABDELHAMID, MANAL (RPH)
7100 BOULEVARD EAST, 11G
GUTTENBERG, NJ 07093

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/15/2001 Permanent
ABDOLLAHI, MITRA (DMD)
646 N. SARATOGA DRIVE
MOORESTOWN, NJ 08057

NPI-1033329230
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/5/2007 7/19/2019
ABERBACH, STEVEN (RPH)
23 STONEGATE DRIVE
WATCHUNG, NJ 07069

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/19/2003
ABOOD, ABDOLMAID S.
64 BEVAN STREET
JERSEY CITY, NJ 07306

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/7/1997
ABOUELHODA, AHMED (RPH)
33-17 60TH ST. APT. 1
WOODSIDE, NY 11377

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2005
ABRAHAMSEN, SVEND (DPM)
101 CHESTNUT RIDGE ROAD
SADDLE RIVER, NJ 07458

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/1994 Permanent
ABRAMS, DE'NYSHIA (CHHA)
410 3RD AVENUE, APT. 1A
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2018
ABRAMS, IRVING (RPH)
5 LORGENE WAY
MORGANVILLE, NJ 07551

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/27/2000
ABREU MARTINEZ, CAROLINA (CHHA)
14 EAST RUSSELL STREET
CLIFTON, NJ 07011

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/31/2017
SUTEX MEDICAL TRANSPORT
814 74TH STREET
NORTH BERGEN, NJ 07047

ABUSEF, ELSAYED K.
814 74TH STREET
NORTH BERGEN, NJ 07047

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/1999 Permanent
ACKLEY, GEORGE (PSYCH)
202 LENOX AVENUE
CAPE MAY , NJ 08204

NPI-1457535833
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/21/2015
ACOSTA, LEILANI (CHHA)
458 STEVENSON PLACE, FLOOR 1
PERTH AMBOY, NJ 08861

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/9/2019
ACOSTA, PEDRO E.
5815 43RD AVENUE 1ST FL
QUEENS, NY 11377

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2008
ACOSTA, PEDRO E.
5815 43RD AVENUE 1ST FL
QUEENS, NY 11377

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/13/2008
ACOSTA, PEDRO E.
5815 43RD AVENUE 1ST FL
QUEENS, NY 11377

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2011
ACOSTA, WILLIAM R. (MD)
47 OSBORNE STREET
JOHNSTOWN, PA 15905

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
ACQUAH, ROSE AKA MANFORD, ROSE (CHHA)
5507 WARNER VIEW LANE
WESTVILLE, OH 43081

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/13/2018
ACQUAIRE, FLORENCE
EMCF PO BOX 08809
CLINTON, NJ 08809

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2006
ACQUAYE, EDWARD
10 BERWICK CIRCLE
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/19/2007
ACZON, FERDINAND B. (MD)
204 SUMMIT ROAD
MOUNT LAUREL, NJ 08054

NPI-1255422135
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2011 11/23/2016
ADADEVOH, LOVESDALE AKA HAMENOO, LOVESDALE (CHHA)
1 SKYTOP GARDENS, APT. 19
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2019
ADAIR, LISA AKA TARASEVICH, LISA (LPN)
206 LAKEHURST AVE., APT.B
NATIONAL PARK, NJ 08063

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
ADAMS, AMELIA (CHHA)
132 OAKMONT ROAD
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
ADAMS, ANTOINETTE (CHHA)
1604 SEWALL AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
ADAMS, JAIME L. (CHHA)
911 W. HAND AVE
CAPE MAY CT. HS, NJ 08210

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
ADAMSHICK, WILLIAM (RPH)
2516 HURRY ROAD.
FORKED RIVER, NJ 08731

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/14/2005 3/21/2012
ADDIS, DAVID J. (MD)
334 FARNSWORTH AVENUE
BORDENTOWN, NJ 08505

NPI-1770656068
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/20/2015 Permanent
ADES, ALBERT (DR'S OFFICE)
MIAMI FCI, PO BOX 779800
MIAMI, FL 33177

NPI-1447560867
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/16/2017
ADES, ALBERT (MD)
3 MARKHAM CIRCLE
ENGLEWOOD, NJ 07631

NPI-1912069394
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/16/2016
ADES, ALBERT (MD)
PO BOX 779800, #67194-050
MIAMI, FL 33177

NPI-1912069394
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/12/2016
ADISSON, LECLERC (MD)
1482 SW 150TH TERRACE
SUNRISE, FL 33326

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2007 Permanent
ADISSON, LUNIC (CHHA)
14 WALTER PLACE #1
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/14/2008 Permanent
ADOLPHE, NAOMIE (CHHA)
410 FISHER AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
ADU-BOAHENE, KWABENA (CHHA)
3 AUGUSTA DRIVE
LITTLE EGG HARBOR, NJ 08087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
AFRIYIE, BRIGHT (CHHA)
317 W. RUNYON STREET, 3L
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
AGARWAL, SHASHI K. (MD)
FCI SCHUYLKILL, PO BOX 759
MINERSVILLE, PA 17954

NPI-1558416099
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

2/28/2014
AGARWAL, SHASHI, K. (MD)
198 CENTRAL AVENUE 1ST FL
EAST ORANGE, NJ 07018

NPI-1558416099
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/22/2012
Agostino Ducato, VP

,

NPI-

Criminal Offense




AGRAWAL, PANKAJ (MD)
3 E MEADOWBROOK CIRCLE
SICKLERVILLE, NJ 08081

NPI-1962661215
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/2006
AGRESTA JR., RUDOLPH (MD)
P.O. BOX 7450
TRENTON, NJ 08628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
AGRESTI, JAMES (MD)
292 FAIRMONT ROAD
LONG VALLEY, NJ 07853

NPI-1255389813/1477874352
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/5/2020
AGRESTI, ROBERT (MD)
15 BARBERRY WAY
ESSEX FALLS, NJ 07021

NPI-1619155710
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/26/2018
AGUH, CHIKEZIE (MD)
18 MULBERRY COURT
BELLE MEAD, NJ 08502

NPI-1407876261/1619997483
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2021
AGUIAR, SANDRA
605 KNICKERBOCKER ROAD
TENAFLY, NJ 07670

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/18/2009
AGUILAR, RUBEN (RPH)
16 GOLDENROD DRIVE
BELLE MEAD, NJ 08502

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2010
AGUIRRE-MEDRANO, CANDIDA
40 FERRY STREET
NEWARK, NJ 07105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/12/1999 Permanent
American Eagle Contractor, Inc.
420 Broadway
Long Branch, NJ 07740

Agustin Zuniga, President
420 Broadway
Long Branch, NJ 07740

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/12/2014 08/11/2017
AGYEMANG, JOHN (RPH)
153 BLUE MEADOW LANE
SICKLERVILLE, NJ 8081

NPI-1487934626
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/28/2016 9/22/2020
VICTORY PHARMACY
94 MARKET STREET
NEWARK, NJ 07102

AGYEMANG, KWADWO (RPH)
94 MARKET STREET
NEWARK, NJ 07102

NPI-1154713394

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/25/2003 6/3/2015
AHLAWAT, RANVIR (MD)
2204 ARVELL STREET
TOMS RIVER, NJ 08755

NPI-1447204615
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/19/2016
AHMAD, ABADULLAH
280 LUIS MARIN BLVD #15
JERSEY CITY, NJ 07302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2009 Permanent
AHMAD, FAROOQ (RPH)
300 EAST HALSEY ROAD
PARSIPPANY, NJ 07054

NPI-1659605590
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/8/1994
GARDEN DRUGS INC./NEW HEALTH CARE PHARM./SAIRA SONIA INC.
682 BERGEN AVENUE
JERSEY CITY, NJ 07306

AHMAD, NAEEM S.
682 BERGEN AVENUE
JERSEY CITY, NJ 07306

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/15/1983 Permanent
AHMAD, NAVEED (MD)
48 SUYDAM ROAD
SOMERSET, NJ 08873

NPI-1669412946
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2016 Permanent
AHMAD, NAVEED (MD)
48 SUYDAM ROAD
SOMERSET, NJ 08873

NPI-1669412946
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2016 Permanent
AHMED, AMIR E.
7-11 TONNELLE AVE - 2MN
JERSEY CITY, NJ 07306

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/30/1997 Permanent
AHMED, KHALID H.
PO BOX 930
NEW YORK, NY 10013

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/26/1994 Permanent
AHMED, MOHAMED G. (PHARM TECH)
5 WESTOVER TERRACE
WEST ORANGE, NJ 07052

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2010
AIRD, EILEEN B.
295 GRANDVIEW CIRCLE
RIDGEWOOD, NJ 07450

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
AKANDE, EZEKIEL (MD)
300 HAIL KNOB ROAD, #290828
SOMERSET, KY 42503

NPI-1003859885
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2017
AKHMEDOV, KHUSEN
SCI GRATERFORD, ME9849, PO BOX 244
GRATERFORD, PA 19426

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
AKHTAR, NADEEM (RPH)
15 GRIST MILL LANE
UPPER SADDLE RI, NJ 07458

NPI-1063695963
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/20/2012
AKHTAR, NADEEM (RPH)
15 GRISTMILL LANE
UPPER SADDLE RI, NJ 07458

NPI-1063695963
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012
AKINBILE, MORUFU O. (RN)
419 E. MOOREHAVEN DRIVE
CARSON, CA 90746

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2010
AKODA, CHARLES AKA IGBERASE, OLUWAFEMI AKA IGBERASE, CHARLES (RN)
14909 DOWNEY COURT, SUITE 200
BOWIE, MD 20721

NPI-1609033042
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2018
AL SALIHI, FAROUK (MD)
1810 JOHN F. KENNEDY BLVD
JERSEY CITY, NJ 07305

NPI-1720158025
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/1/2011
AL SALIHI, FAROUK (MD)
1810 JOHN F. KENNEDY BLVD
JERSEY CITY, NJ 07305

NPI-1720158025
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/9/2015
S & S Electric, LLC
108 Oak Glen Road
Toms River, NJ 08753

Al Shan, President
108 Oak Glen Road
Toms River, NJ 08753

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/13/2015 01/12/2018
TEMPT TRANSIT, INC.
238 MAIN STREET
HACKENSACK, NJ 07601

ALAMEEN, ALWALEED
238 MAIN STREET
HACKENSACK, NJ 07601

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/1995
Alan Lombardi, President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/10/2014 12/9/2017
ALAN, DAVID
203 NORTH REDWOOD STREET
MASONTOWN, PA 15461

NPI-1225012073
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
ALBERS, HENRY J. (EMT)
3 QUEEN STREET
PARSIPPANY, NJ 07054

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/9/1996 Permanent
Kitchen Crafters Plus d/b/a B&B Custom Cabinets
1 Suydam Place
Aberdeen, NJ 07747

Albert Brisebois, Owner
1 Suydam Place
Aberdeen, NJ 07747

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/1/2015 05/31/2018
Ren Construction
1984 Whitesville Rd
Toms River, NJ 08755

Albert Chwedczuk, Owner
1984 Whitesville Rd
Toms River, NJ 08755

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/10/2014 07/09/2017
ALBINO, ETHAN (RN)
224 FERN AVENUE
HADDON TOWNSHIP, NJ 08108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/7/2017
ALCAIDE, KELLY (LPN)
716 RIVER ROAD
SOMMERVILLE, NJ 08844

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
ALEXANDER, EDWARD J. (MD)
8001 CASTOR AVE., STE 326
PHILADELPHIA, PA 19152

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/8/2000 Permanent
ALEXANDER, JULIE B. (RPH)
1525 DOGWOOD DRIVE
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
ALEXANDER, MARVIN
52 S. JEFFERSON ST.
ORANGE, NJ 07050

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/4/2013 12/3/2016
ALEXANDRA, ALYCIA AKA DOTRO, ALYCIA (RN)
6 LOWELL ROAD
MANALAPAN, NJ 07726

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2019
ALFONSO, NORMA (CHHA)
144 SUMMIT STREET
ENGLEWOOD, NJ 07631

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/1997
Allied Construction LLC.Allied Construction Management, LLC
100 Dobbs Lane Suite 102
Cherry Hill, NJ 08034

Alfred Sciubba, Managing Member
3 Chadwick Drive
Voorhees Twp., NJ 08043

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/22/2013 10/21/2016
AL-GHRAOUI, FADI (MD)
PO BOX 23429
FORT LAUDERDALE, FL 33307

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2004 DECEASED
ALI, HANIFAH (CHHA)
1216 FALCON DRIVE
ABSECON, NJ 08201

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
ALI, MOHAMED T. (MD)
64 BEVAN STREET
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/31/1994 Permanent
ALI, RAUSHANAH (LPN)
103 BONNIA AVENUE
TRENTON, NJ 08629

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/3/2019
ALI, SAQIB
MDC BROOKLYN, PO BOX 3290
BROOKLYN, NY 11232

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2012
TARIK TRANSPORTATION SVC.
566 BLOOMFIELD AVENUE
BLOOMFIELD, NJ 07306

ALI, TARIK
566 BLOOMFIELD AVENUE
BLOOMFIELD, NJ 07306

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/10/1999 Permanent
Five Star Quality Construction
141 Rte. 130 South Suite 192
Cinnaminson , NJ 08077

Alicirio Jose Santana Pires, Owner
141 Rte 130 South Suite 192
Cinnaminson, NJ 08077

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/23/2014 04/22/2017
Vercon Building & Maintenance Corp.
11 Arboretum Dr
Jackson, NJ 08527

Allanur Islambekov, Owner
11 Arboretum Dr
Jackson, NJ 08527

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/12/2014 05/11/2017
ALLEN, ADINA (CHHA)
219 PINEBROOK DRIVE
MANTUA, NJ 08051

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/22/2017
ALLEN, DEBRA (CHHA)
18 REID LANE
MILLSTONE TWP. , NJ 08535

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/6/2019 Permanent
ALLEN, KENNYATTA G.
148 CORNERSTONE PLACE
WHITEHALL, NY 18052

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/14/2008
ALLEN-BROGAN, MELANIE A.
135 WILD OAKS COURT
LITTLE EGG HARB, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/5/2008
ALLRED, ELLEN ANNE (RN)
571 FERNWOOD AVENUE
FAIRLESS HILLS, PA 19030

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
ALPERIN PEDIATRICS, PA
28 RIVERSIDE AVENUE
RED BANK, NJ 07701

ALPERIN, MARTIN (MD)
28 RIVERSIDE AVENUE
RED BANK, NJ 07701

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/19/2000 Permanent
ALPERT, PERRY (DDS)
560 NEWARK AVENUE
ELIZABETH, NJ 07208

NPI-1952668782
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/2/1995 8/26/2020
ALSTON, SHERRELLE
NORTH 52ND STREET
PHILADELPHIA, PA 19139

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/9/2007
ALTOONIAN, ANN MARIE (RN)
82 CONTANT AVENUE, APT. 2
LODI, NJ 07644

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2019
ALVIS, SANDRA (CHHA)
1421 HOLLINSHED AVENUE
PENNSAUKEN, NJ 08110

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
CRESCENT EXPRESS
24 BRANFORD PLACE
NEWARK, NJ 07102

ALY, ABUBAKR
24 BRANFORD PLACE
NEWARK, NJ 07102

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/2004
ALY, AHMED F. (RPH)
1030 LIBERTY AVENUE
UNION, NJ 07083

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/17/2007
CLIFTON FAMILY PHARMACY
1137 MAIN AVENUE
CLIFTON, NJ 07011

ALY, WAEL
1137 MAIN AVENUE
CLIFTON, NJ 07011

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/30/2000
OMARS PHARMACY, INC.
1137 MAIN AVENUE
CLIFTON, NJ 07011

ALY, WAEL
1137 MAIN AVENUE
CLIFTON, NJ 07011

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/30/2000
AMABILE, JOHN C. (OD)
HIGHWAY #35 & 3RD AVENUE
OCEAN, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/2002 Permanent
AMAKER, PHYLLIS (CHHA)
475 LIVINGSTON DRIVE
EAST WINDSOR, NJ 08520

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
AMANKWAH, VINCENTIA
8 MAPLES AVENUE
CLIFFWOOD, NJ 07721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
AMANKWAH, VINCENTIA
8 MAPLES AVENUE
CLIFFWOOD, NJ 07721

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/1/2016
AMATO, CARLO (DC)
500 RIVER AVENUE
LAKEWOOD, NJ 08701

NPI-1275673360
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/18/2018
AMATO, NICOLA (DC)
3 MULLIGAN DRIVE
FLANDERS, NJ 07836

NPI-1366941627
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
AMATO, STEVEN P. (DC)
30151 FISH ROCK ROAD
YORKVILLE, CA 95494

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2009
AMATO, VANESSA A. AKA NOWINSKI, VANESSA (RN)
65 LOCUST AVENUE
N. ARLINGTON, NJ 07031

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
AMBROSE, DEAN A. (DO)
119 NORTH CETNTRE STREET
MERCHANTVILLE, NJ 08109

NPI-1598832560
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/1/2002
AMENYITOR, APEAFA (CHHA)
14 MARSHALL STREET, APT. 14W
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
AMES, TISHEENA (CHHA)
96 HALSEY REED ROAD
CRANBURY, NJ 08512

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2018
AMIN, PRISCILLA (CHHA)
133 ATLANTIC STREET
HACKENSACK, NJ 07601

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/23/2017
AMON, TAMERLANE (CNA)
394 EGE AVENUE
JERSEY CITY, NJ 07304

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2018
AMON, TAMERLANE (CNA)
394 EGE AVENUE
JERSEY CITY, NJ 07304

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
AMPARO, VIANNE AKA PAYANO, VIANNE (CHHA)
710 EAST 18TH STREET
PATERSON, NJ 07501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
AMPOFO, TWUMASI
12 MARSHALL STREET #7W
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/1/2008
AMPOFO, TWUMASI
12 MARSHALL STREET #7W
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/30/2009
ANAND, NEIL (MD)
26 TAFT LANE
MORRISTOWN, NJ 07960

NPI-1982626818
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/18/2019
ANAND, SUBINA (DMD)
17 GROVERS MILL ROAD
IRVINGTON, NJ 07111

NPI-1982781589
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2012
ANAND, SUBINA (DMD)
17 GROVERS MILL ROAD
PLAINSBORO, NJ 08536

NPI-1982781589
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2012
ANDERSON, CHARMAINE (RN)
95 FARRAGUT ROAD
NORTH PLAINFIELD, NJ 07062

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
ANDERSON, DAVID (RN)
519 HOBART AVE.
TRENTON, NJ 08629

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2003
ANDERSON, FRANCINE (CHHA)
901 PRINCETON AVENUE
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/12/2018
ANDERSON, JOHN P. (MD)
362 S. LAUREL STREET
WAYNEBORO, VA 22980

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/1999
ANDERSON, NICOLE (RN)
1801 HUNTINGTON MEWS
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
ANDRADE, GLORIA (LCSW/LCADC)
679 GRANT TERRACE
TEANECK, NJ 07666-

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/18/2018
ANDREWS, TANELLE (RN)
1340 S. ORCHARD ROAD
VINELAND, NJ 08360

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2019
Andrzej Citak, Vice-President
556 Humboldt Street
Brooklyn, NY 11222

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/24/2014 09/23/2017
A.J. Skora Inc.
1982 Route 9
Toms River, NJ 08753

Andrzej Skora, President
67 Cox Cro Road
Toms River, NJ 08755

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/19/2013 08/18/2016
ANDUJAR, EDWARD (MD)
516 E. WOOD STREET
VINELAND, NJ 07410

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/20/2006
ANELLO, ALLYSON (PHARM TECH)
708 FOX HILL DRIVE
DOVER, NJ 07801

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2018 Permanent
ANEROUSIS, MARY DEE (DDS)
283 SOUTH ORANGE AVENUE
LIVINGSTON, NJ 07039

NPI-1871675769
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2019
ANGEL, CHRISTINA (CHHA)
145 PRESIDENTIAL BOULEVARD, APT. 16J
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
ANGELES, KATHERINE (MD)
191 ROUTE 37 WEST
TOMS RIVER, NJ 08755

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/23/1995 DECEASED
I.K.E. Electrical Corp.
48 E. Central Blvd.
Palisades Park, NJ 07650

Angelo Castelli, President
100 W Forest Ave Building E
ENGLEWOOD, NJ 07631

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/21/2014 07/20/2017
ANGELO, JOSEPH
34 STONEHEDGE ROAD
LINCROFT, NJ 07738

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/27/1993 Permanent
Lombardi Enterprises, Inc.
26 Whispeiring Way
Berkeley Heights, NJ 07922

Ann Lombardi, Secretary
2901 South Clinton Ave
South Plainfield, NJ 07080

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/10/2014 12/09/2017
ANODIDE, PAUL A. (DDS)
23 BLUE DEVIL LANE
TRENTON, NJ 08619

NPI-1841317625
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/3/2006
ANSERE, PATIENCE (CHHA)
305 COOLIDGE AVENUE
ENGLEWOOD, NJ 07631

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/17/2018
ANTELL, CLIFF #65502-050
FCI CUMBERLAND, PO BOX 1000
CUMBERLAND, MD 21501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
Anthony Davis, Vice-President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/29/2013 10/28/2016
Samco Construction Co. LLC
413-415 South Seventh St.
Elizabeth, NJ 07202

Anthony Mirabile, President
413-415 South Seventh St.
Elizabeth, NJ 77202

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/3/2013 07/02/2016
ANTHONY, QUINT (LPN)
PO BOX 214
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
ANTONE, JULIE (LCSW)
366 CAMBRIDGE DRIVE
RAMSEY, NJ 07446

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2013
Crossroad Construction Corp.
312 Emmet Street
Newark, NJ 07114

Antonio Gomes Sr., President
164 Green Street
Newark, NJ 07105

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/13/2013 05/12/2016
Pax Construction Corp.
159 Locust Avenue
West Long Branch, NJ 07764

Antonio Pereira, President
67 Highway 36
West Long Branch, NJ 07764

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/17/2014 10/16/2017
ANTWI, ISAAC (CHHA)
549 BOLTON AVENUE #1
BRONX, NY 10473-

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/28/2018
ANZALONE, ANTHONY (MD)
203 DIETZ STREET
CRANFORD, NJ 07016

NPI-1124071857
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2019
New Jersey State Floring, Inc.
109 Greentree Road
Brick, NJ 08724

APGAR, CHERYL
109 Greentree Road
Brick, NJ 08724

NPI-

Construction
Wage & Hour Violation
Debarment

Treasury
2650

4/8/2016 4/10/2019
APGAR, ROY
109 Greentree Road
Brick, NJ 08724

NPI-
Construction
Wage & Hour Violation
Debarment

Treasury
2650

4/8/2016 4/10/2019
APONTE, DENNIS (MD)
MDC BROOKLYN - PO BOX 329002
BROOKLYN, NY 11232

NPI-1053458018
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
AQUILANTE, JOHN C. (RPH)
27 ROCKLEDGE PLACE
CEDAR GROVE, NJ 07009

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/1983 Permanent
ARDAN, MARGO (RN)
161 CONAWAGA TRAIL
MEDFORD, NJ 08055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
ARDEHALI, MOHAMMED (MD)
193 ELMWOOD AVENUE
NEWARK, NJ 07104

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2001
ARGUETA, ALVARO (MD)
9408 BIG VIEW DRIVE
AUSTIN, TX 78730

NPI-1194851618
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017 Permanent
ARGUETA, EDWARD A. (CNA)
604 N. BAYVIEW AVENUE
SEASIDE PARK, NJ 08752

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/13/1999
ARGUETA, EDWARD A. (CNA)
604 N. BAYVIEW AVENUE
SEASIDE PARK, NJ 08752

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/8/1999
ARIF, MOHAMMED
147-14 14TH AVENUE
WHITESTONE, NY 11375

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
Real Construction LLC
1984 Whitesville Rd
Toms River, NJ 08757

Arkadiusz Chwedczuk, Owner
719 11th Ave
Toms River, NJ 08757

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/24/2014 11/23/2017
Conex Construction Corp.
265 Wilson Avenue
Kea(RN)y, NJ 07032

Armando Piedade, President
265 Wilson Avenue
Kearny, NJ 07032

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/20/2016 01/19/2019
ARMBRISTER, KATIMA (CHHA)
301 BELMAR AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
ARNESON, VICTORIA (RN)
42 HOLLY STREET
CRANFORD, NJ 07016

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
AROWOSAYE, EMILY (RN)
24 CUNNINGHAM DRIVE
WEST ORANGE , NJ 07052

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/31/2010
AROWOSAYE, EMILY (RN)
24 CUNNINGHAM DRIVE
WEST ORANGE, NJ 07052

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2012
AROWOSAYE, ISAAC
24 CUNNINGHAM DRIVE
WEST ORANGE, NJ 07052

NPI-
Professional
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/30/2010 DECEASED
AROWOSAYE, ISAAC
24 CUNNINGHAM DRIVE
WEST ORANGE, NJ 07052

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/4/2014 DECEASED
MG Topflight
6 Spruce Meadows Dr
Monroe, NJ 08831

Ashish Thomas, Owner
6 Spruce Meadows Drive
Monroe, NJ 08831

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/29/2014 07/28/2017
ASHOKAN, ANNAMALAI (MD)
7 ROCKLEDGE DRIVE
SUFFERN, NY 10901

NPI-1497857270
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/1/2004
ASKANAZI, JEFFREY (MD)
2322 OLDE FARM LANE
HUDSON, OH 44236

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/19/1999 Permanent
ASLAM, ZAHID (MD)
1814 E. 2ND STREET
SCOTCH PLAINS, NJ 07076

NPI-1306906854
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/16/2019 Permanent
ASTON, ALEXIA L. (LPN)
15 PRIMROSE LANE, APT. 3
DELRAN, NJ 08075

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/18/2009
ASTORE, MARYANN (CHHA)
45 KOHOMO AVENUE
ERIAL, NJ 08081

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/30/2019
ATIENZA, CESAR P. (MD)
56 COLD INDIAN SPRING RD
OCEAN, NJ 07712

NPI-1164491494
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/6/1991 Permanent
ATKINS, DAWN AKA STILL, DAWN (CHHA)
697 EVERETT STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
AUFSEESER, LESLIE (DPM)
111 MEADOWS LANE
WAYSIDE, NJ 07712

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/12/2018
AUSTIN, BRITTANY (CHHA)
420 N. SOUTH CAROLINA AVENUE
ATLANTIC CITY, NJ 08401

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/6/2018
GERI CARE CENTERS INC
31 MADISON AVENUE
MONTCLAIR, NJ 07042

AUSTIN, DONALD P
31 MADISON AVENUE
MONTCLAIR, NJ 07042

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
AUSTIN, NIDERIA (CHHA)
822 GALINDEZ COURT
CAMDEN, NJ 08102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/15/2017
AVILES, REBECCA (CHHA)
67 MILL ROAD
LEVITTOWN, PA 19057

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
AYALA, ANDRES
33 MADISON AVENUE
CHERRY HILL, NJ 08002

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/11/2017 10/3/2019
AYALA, ANDRES
33 MADISON AVENUE
CHERRY HILL, NJ 08002

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
AZAM, CHOWDHURY F. (MD)
38 ORIOLE DRIVE
HACKETTSTOWN, NJ 07840

NPI-1922053792
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/1/1999 6/30/2015
AZAM, CHOWDHURY F. (MD)
30 DUNSTON LANE
MONMOUTH JUNCTION, NJ 08852

NPI-1922053792
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/26/2016
AZIZ-DURRANI, MUMLIKAT
328 SIP AVENUE
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
GOODWILL PHARMACY
2836 DEBRA WAY
UNION, NJ 07083

AZU, PHILIP N. (RPH)
2836 DEBRA WAY
UNION, NJ 07083

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/1999 Permanent
AZU, PHILIP N. (RPH)
1094 CLINTON AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2001 Permanent
BABARIA, ASHOKKUMAR (MD)
FCI FORT DIX PO BOX 2000
FORT DIX, NJ 08640

NPI-1538100599
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/4/2014
BABARIA, ASHOKKUMAR (MD)
5756 HARTFIELD/POINTVILLE
FORT DIX, NJ 08640

NPI-1538100599
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2015
BABARIA, ASHOKKUMAR (MD)
208 QUAKERBRIDGE COURT
MOORESTOWN, NJ 08057

NPI-1538100599
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/10/2012
BABAYANTS, ALEXANDER (MD)
184 S. LIVINGSTON AVENUE #9272
LIVINGSTON, NJ 07039

NPI-1194779371
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/10/2018
BACSENKO, JENNIFER (PHARM TECH)
103 STATE STREET
LINWOOD, NJ 08221

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2011
BADAWT, BADAWY AKA BADAWY BADAWY (MD)
2738 KENNEDY BOULEVARD 1ST FL
JERSEY CITY, NJ 07306

NPI-1679615553
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
BADAWT, BADAWY AKA BADAWY BADAWY (MD)
2738 KENNEDY BLVD 1ST FL
JERSEY CITY, NJ 07306

NPI-1679615553
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/25/2013
BADAWY, BADAWY AKA BADAWY BADAYT (MD)
2738 KENNEDY BOULEVARD 1ST FL
JERSEY CITY, NJ 07306

NPI-1679615553
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
BADAWY, BADAWY AKA BADAWY BADAYT (MD)
2738 KENNEDY BLVD 1ST FL
JERSEY CITY, NJ 07306

NPI-1679615553
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/25/2013
BADO, JEFFREY (DO)
1615 ASHBOURNE ROAD
ELKINS PARK, PA 19027

NPI-1801908173
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BADO, JEFFREY (DO)
FDC PHILADELPHIA #71927-066, PO BOX 562
PHILADELPHIA, PA 19105

NPI-1801908173
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2017
BADUINI, JOLIE (RN)
1300 32ND AVE SW, APT 307
MINOT, ND 58701

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
BAER, MICHAEL L. (DC)
BAYSIDE STATE PRISON
LLESBURG, NJ 08327

NPI-1053654616
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2004
BAEZ, ANNA V. (DDS)
911 VILLAGE DRIVE
SOMERSET, NJ 08873

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
BAFFOWAAH, ZIBORAH
4345 DIAMOND DRIVE
SAINT PAUL, MN 55122

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2015
BAGDASAROVA, ANGELICA (RN)
11981 AUDUBON AVENUE
PHILADELPHIA, PA 19116

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BAH, HUSAINATU (RN/LPN)
2510 BIRCHWOOD COURT
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/15/2016 12/10/2019
BAH, HUSAINATU (RN/LPN)
2510 BIRCHWOOD COURT
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/28/2013 12/10/2019
BAHNSON, WILLIAM F. (MD)
28 HIGH STREET
TREENFIELD, MA 01301

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

9/2/1988 DECEASED
BAILEY, FREDERICK (DDS)
41 WEST GLEN ROAD
DENVILLE, NJ 07834

NPI-1205048410
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2016
BAILEY, KENNETH
231 MAIN ST., PO BOX 12
HEISLERVILLE, NJ 08342

NPI-
Vendor
Industry Law Violation
Construction

Treasury
Treasury Purchase Bureau

5/7/2015 5/7/2020
BAIRD, DAVID B. (MD)
4107 MERCHANT SQ. PLACE
LANSDALE, PA 19446

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
BAJAKIAN, BRYAN (DC)
3105 STOWE LANE
MAHWAH, NJ 07430

NPI-1679618094
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2010
BAJWA, LATIF AHMAD
PO BOX 633
LANGHORNE, PA 19047

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/9/2009
BAKER, MONIQUE (CHHA)
1521 NEWPORT STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2019
BAKER, SCOTT (CNA)
215 BURLINGTON RD. SOUTH
BRIDGETON, NJ 08302

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/2002
BAKMAN, MILANA (CHHA)
4 IVY WAY
DAYTON, NJ 08810

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/19/2018
BALLERAS, ALFREDO B. (RPH)
1 VISTA DRIVE
MOUNT OLIVE, NJ 07836

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/14/2010 9/13/2013
BAMDAD, BABAK (RPH)
2 SOUTH GATE ROAD, APT 736
GREAT NECK, NY 11023

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/26/2011
BAMDAD, BABAK (RPH)
333 RIVER STREET
HOBOKEN, NJ 07030

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

6/1/2010
BAMGBOYE, PATRICK (DDS)
358 MEISEL AVENUE
SPRINGFIELD, NJ 07081

NPI-1720175508
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/7/2012
BANDY, ANHUAR
141 CRINE ROAD
COLTS NECK, NJ 07722

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
BANDY, KARIM
141 CRINE ROAD
COLTS NECK, NJ 07722

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
BANGOURA, ALPHA
200 EXECUTIE DRIVE
WEST ORANGE, NJ 07050

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/22/2006
BANKA, VIDYA (MD)
237 STACEY ROAD
PENN VALLEY , PA 19072

NPI-1588659965
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/19/2018
GENE'S PHARMACY
640 PINE STREET
CAMDEN, NJ 08103

BANKS, KENNETH
640 PINE STREET
CAMDEN, NJ 08103

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/14/2003
BANNON, JOSEPH
250 GORGE ROAD
CLIFFSIDE PARK, NJ 07010

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/25/2011 11/24/2014
BAPTISTE, STANLEY (CHHA)
401 WEST VIRGINIA AVENUE, APT. B-16
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
BARAHONA, RONY
549 SUMMIT AVENUE
MAPLEWOOD, NJ 07040

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/26/2013
BARAN-DICRISCIO, LORRAINE (CHHA)
309 IRIS ROAD
CHERRY HILL, NJ 08620

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
BARAQUE, IVAN DARIO (MD)
4 WOODCREST COURT
WEST NYACK, NY 10994

NPI-1811059967
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2015
BARASCH, MILTON (RPH)
12 IVY WAY
ABERDEEN, NJ 07747

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/3/2000 Permanent
BARATTI, CARMEN (DO)
150 KIRKBRIDGE ROAD
VOORHEES, NJ 08043

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/4/1997
BARBA, FIDELIS (MD)
2 POWDER HILL
SADDLE RIVER, NJ

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/11/2000 Permanent
BARBANEL, JACOB
4656 PARK LANE
WALNUTPORT, PA 18088

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/7/2015 4/6/2018
The Boca Bay Group
163 Hillcrest Ave
Cranford, NJ 07016

Barbara Marano, President
16 South Ave West Suite 267
Cranford, NJ 07016

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/21/2013 05/20/2016
BARBER-HINSON, CONNIE
7011 SHADOW RUN
SAN ANTONIO, TX 78250

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2011
BARBERS-WEBER, JENNIFER
8 ELKRIDGE PARKWAY
MANALAPAN, NJ 07726

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

11/5/2009
BARDEN, BRENDA (RN)
19 INTERVALE ROAD
SALEM, MA 01970

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2012
BARDO, MANUEL
11756 SW 14TH TERRACE
MIAMI, FL

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
BARET, MICHELLE (CHHA)
135 MARINA DRIVE
EDISON, NJ 06076

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
BARGE, NICHOLAS
716 NAUTILUS STREET
FORKED RIVER, NJ 08731

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/16/2011
BARI, ABDUL
264 PROSPECT STREET
NUTLEY, NJ 07110

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/19/2009
BARIEXCA, CARLA (LPN)
107 DAYTON STREET
TRENTON, NJ 08610

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2006
BARNA, ARLENE (RN)
205 KRAFT AVE.
OAKLYN, NJ 08107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
BARNEY, WILLIAM
73 HAMPTON GATE DRIVE
SICKLERVILLE, NJ 08061

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001
BARNWELL, LATANYA
1048 PENNINGTON ROAD
EWING, NJ 08618

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/16/2011 9/17/2014
BARON, MICHAEL B. (MD)
SE 1256 BISHOP BLVD, STE1
PULMAN, WA 99163

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/11/2000 Permanent
BARONE, THOMAS (DO)
255 17TH STREET
PHILADELPHIA, PA 19103

NPI-1780898965
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BARRETTI SR., PHILIP
466 BLOOMFIELD AVENUE
NEWARK, NJ 07107

NPI-
Vendor
Organized Crime Control Act
Suspension

Treasury
Treasury Purchase Bureau

1/9/1996
BARROUS, FELIPE (EMT)
40 KNOLL TERRACE
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2015
BARSH, LAUREN AKA MCCABE, LAUREN (RN)
9 FIELDCREST WAY
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/30/2019
BARTLOW, BRIAN
551 PARKWOOD AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/17/2003
BAS, KONSTANTIN
2800 COYLE STREET #625
BROOKLYN, NY 11235

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/14/2018
BASBUS, VICTOR M. (MD)
33 5TH AVENUE, APT 1B
NEW YORK, NY 10003

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/6/2009 Permanent
BASCUS, NAOMI AKA DERRICK, NAOMI (RN)
6 ENGLISH IVY DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/9/2020
BASCUS, NAOMI AKA DERRICK, NAOMI (RN)
6 ENGLISH IVY DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2016
BASSO, NICHOLAS V. (MD)
7665 MAPLE AVENUE
PENNSAUKEN, NJ 08109

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/1/2000 Permanent
BATARSEH, BASEL (MD)
620 FAIRLAWN AVENUE
GLEN ROCK, NJ 07410

NPI-1063602696/1891803318
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/31/2017
BATARSEH, BASEL (MD)
85 VINCENT DRIVE
CLIFTON, NJ 07013

NPI-1063602696/1891803318
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2018
BATEMAN, PAMELA (LPN)
91 CHESTNUT STREET
SALEM, NJ 08079

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/21/2008
BATES, NANCY M. (DO)
38 PALSA AVENUE
ELMWOOD PARK, NJ 07407

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/3/2001 Permanent
BATTLE, TIFANY (CHHA)
393 IRVINE TURNER BOULEVARD, APT. 4D
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
BAUBLITZ, CARRIE (RN)
80 CONEWAGO DRIVE
HANOVER, PA 17331

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
BAUTISTA, FILOMENA (CHHA)
133 PAMRAPO AVENUE #1
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
BAXTER, LOUIS E. (MD)
2 MANCHESTER COURT
COLUMBUS, NJ 08022

NPI-1962527051
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

10/26/1983 4/2/2013
BEACHUM-THOMPSON, AMY (CHHA)
201 WEBSTER STREET
WOODBINE, NJ 08270

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/2018 8/20/2018
BEALS, PAUL V. (MD)
4120 WESTFIELD AVENUE
PENNSAUKEN, NJ 08110

NPI-1427175652
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/24/2014
BEASLEY, BRANDI (C N A)
433 ALFRED ROAD
TOMS RIVER, NJ 08757

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2019 Permanent
BEAUCEJOUR, MONIQUE (CHHA/CNA)
204 BERKELEY AVENUE, APT. 323
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2019
BECK, ALLAN G. (MD)
1833 ARROWHEAD DRIVE
WATERFORD, NJ 08089

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2001
BECKETT, DONALD (DPM)
10144 DEERCLIFF DRIVE
TAMPA, FL 33647

NPI-1871692285
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/4/2005
BECKFORD, AUDREY L.
566 NORTH MAPLE AVENUE
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2002
BEDRICK, BERNARD A.
300 EAST 56TH STREET
NEW YORK, NY 10022

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
BEECHER, GEORGE (MD)
137 EVERGREEN AVENUE
NW PROVIDENCE, NJ 07974

NPI-1073574059
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/8/2016 9/19/2018
BEECHER, GEORGE (MD)
137 EVERGREEN AVENUE
NW PROVIDENCE, NJ 07974

NPI-1073574059
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2018
BEHRMAN, EDWARD (DO)
520 HAMBURG TURNPIKE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
BEIRNE, MARY F. (MD)
75 ABE VORHEES AVENUE
MANASQUAN, NJ 08736

NPI-1881782662
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001 5/16/2011
BEKIER, JACQUELYN (CHHA)
518 LAKE TERRACE
BRADLEY BEACH, NJ 07720

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BELIAEV, KIRA (CHHA)
108 36TH STREET
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
BELKOFF, MEYER (DO)
29 ELMORA AVENUE
ELIZABETH, NJ 07202

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/1998 DECEASED
BELL, BEANA
9926 HALDEMAN AVENUE
PHILADELPHIA, PA 19115

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BELL, KIMBERLY (RN)
2030 HIGHWAY 35 N. UNIT K
ORTLEY BEACH, NJ 08735

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001 2/7/2020
BELL, SHANNON (PHARM TECH)
6591 MILL ROAD
EGG HARBOR TOWNSHIP, NJ 08234

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/23/2017
BELLAMY, BERNICE
27 VILLAGE DRIVE
LUMBERTON, NJ 08060

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/20/2004 Permanent
H & B TRANSP
401 SOUTH WHITEHORSE PIKE
MAGNOLIA, NJ 08049

BELLAMY, HARVEY OWNER
CRAF PO BOX 7450
TRENTON, NJ 08625

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2004 Permanent
BELLO, REY N. (MD)
444 60TH STREET
WEST NEW YORK, NJ 07093

NPI-1780796409
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/31/2011 Permanent
BELONY, IVELYSE (LPN)
131 PARK PLACE, APT. 1
IRVINGTON, NJ 07111-

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
BELTZER, BLAIR (MD)
2025 HAMBURG TURNPIKE
WAYNE, NJ 07470

NPI-1073635421
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
BENKO, ALICIA #60674-050 (PHARM TECH)
FCI DANBURY RT 37
DANBURY, CT 06811

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/18/2009
BENNETT, SHARON (CHHA)
736 EDGEWOOD AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BENNETT-WILLIAMSON, KATHLEEN (LPN)
75 WALT WHITMAN WAY
TRENTON, NJ 08690

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/27/2001 Permanent
BENSEMKY, AMINA (CHHA)
2828 KENNEDY BOULEVARD, APT. 361
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/26/2019 Permanent
BENSIMHON, GEORGES (MD)
1488 SHELBOURNE COURT
ALLENTOWN, PA 18104

NPI-1649234394
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
BENTLEY, CYNTHIA (RN)
220 GILPIN ROAD
WILLOW GROVE, PA 19090

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2018
BENTON, DEBORAH AKA KING, DEBORAH (LPN)
9 RADFORD PLACE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2001 11/5/2018
BERGER, SHELDON H. (MD)
1032 ROUTE 34
MATAWAN, NJ 07747

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/30/2000 Permanent
BERKELHAMMER, EDWARD (MD)
230 W. JERSEY ST.
ELIZABETH, NJ 07202

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/30/1990 Permanent
BERMAN, LARRY R. (DDS)
308 RARITAN DRIVE
HIGHLAND PARK, NJ 08904

NPI-1326191347
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/24/2010
BERMAN, LARRY R. (DDS)
308 RARITAN AVENUE
HIGHLAND PARK, NJ 08904

NPI-1326191347
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2012
BERRY, BRADLEY D. (MD)
PO BOX 2008
GRUNDY, VA 24614

NPI-
Medical
Industry Law Violation
Disqualification

Law and Public Safety
Consumer Affairs Board of Medical Examiners

6/13/1991 DECEASED
BEST, ALEXANDER C.
P.O. BOX 7000
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2005
BETHEA, ALFREDA (LPN)
1234 PROSPECT STREET
TRENTON, NJ 08638

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
BEUKAS, STEPHEN (DMD)
27 ROUTE 34 NORTH
COLTS NECK, NJ 07722

NPI-1275677213
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/30/2014
BEUKAS, STEPHEN (DMD)
MONMOUTH COUNTY CORRECTIONAL INSTITUTE, 1 WATERWORKS ROAD
FREEHOLD, NJ 07728

NPI-1275677213
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2018
BEYNON SERFASS, LEONOR (RN)
18 WILSON AVENUE
CLARKS SUMMIT, PA 18411

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/30/2017
BEZOZA, HOWARD M. (MD)
PO BOX 372
SADDLE RIVER, NJ 07458

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2003
BHATTI, HAMID
80 MILTON AVENUE, #1522
RAHWAY, NJ 07065

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012 9/10/2019
BIENSTOCK, DOUGLAS (DO)
245 DIAMOND BRIDGE AVENUE
HAWTHORNE, NJ 07506

NPI-1831151356
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
BIENSTOCK, DOUGLAS (DO)
245 DIAMOND BRIDGE AVENUE
HAWTHORNE, NJ 07506

NPI-1831151356
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
BILENKIN, ELANA (MANAGER)
242 COMUNITY CIRCLE
OLD BRIDGE, NJ 08857

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/15/1998 Permanent
BINDER, RANDY (RPH)
FCI PO BOX 1000
OTISVILLE, NY 10963

NPI-1972526572
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015 Permanent
BINDER, RANDY (RPH)
16 WINTER PLACE
ABERDEEN, NJ 07747

NPI-1972526572
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2016 Permanent
BIONDELLO JR., PHILIP
41 CONCORD LANE
BASKING RIDGE, NJ 07920

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
BIRDSALL, HOWARD
120 ASHLEY AVENUE
BRIELLE, NJ 08730

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
1020

2/18/2016 2/18/2021
BIRDSALL, WILLIAM
1902 OAK CIRCLE
TAVARES, FL 32778

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
1020

5/2/2016 5/2/2026
BISHARA, GIRGIS (MD)
859 BRIGHTON PL.
OCEAN CITY, NJ 08226

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/1987 Permanent
BITTNER, MELISSA C. (RN)
436 RIVER DRIVE
WESTVILLE, NJ 08093

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2005 Permanent
BLACKMAN, NOEL (MD)
MOSHANNON VALLEY CI, 555 GEO DRIVE
PHILIPSBURG, PA 16866

NPI-1720209521
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/30/2017 Permanent
BLACKMAN, NOEL (MD)
MOSHANNON VALLEY CI, 555 GEO DRIVE
PHILIPSBURG, PA 16866

NPI-1720209521
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/26/2017 Permanent
BLANCO, ALEX (DPM)
180 LAFAYETTE AVENUE, APT. 12A
PASSAIC, NJ 07055

NPI-1881677987
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/24/2017
BLANCO, LAZARO (PHARM TECH)
401 46TH STREET, APT. 5
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
BLANTON, MALEEK (CHHA)
640 LINE STREET
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
BLAU, SEYMOUR H. (DPM)
36 COLLEGE DRIVE
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2003
BLAZAK, ROBERT (PRESIDENT)
1700 BEACON STREET
TOMS RIVER, NJ 08757

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/29/2011 12/28/2014
BLEIMAN, MICHAEL (MD)
1100 ROUTE 72 WEST, SUITE 304
MANAHAWKIN, NJ 08050

NPI-1821086463
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/27/2017 4/27/2017
BLOT, EDWARD (MD)
274 NORTH CENTER STREET
ORANGE, NJ 07050

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/5/2000 Permanent
BLUM, NOEL
74 TWIN RIVERS DRIVE
EAST WINDSOR, NJ 08561

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
BLY, RODNEY
4737 FRANKFORD AVENUE, 3RD FLOOR
PHILADELPHIA, PA 19124

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BLYN, CHARLOTTE (MD)
511 WINDING WAY
MERION , PA 19066

NPI-1669700910
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BOADU, JACOB (RPH)
EUCLID TERRACE
PARSIPPANY, NJ 07054

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2007
BOAMAH, KWAKU (MD)
101 HAVEN WAY
MORGANVILLE, NJ 07751

NPI-1154413029
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/7/2017 8/2/2019
BOBADILLA, MARIA (CHHA)
85 PRESIDENTIAL BOULEVARD, APT. 2K
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2018
BOBADILLA, MARIA (CHHA)
85 PRESIDENTIAL BOULEVARD, APT. 2K
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2018
BOBRYSHEVA, SVETLANA (CHHA)
29 FOREST GARDEN DRIVE
MATAWAN, NJ 07747

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/26/2017
BOCRA, WILLIAM PRESIDENT
ONE NORTH RHODA STREET
MONROE TWP, NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/7/2012 2/6/2015
BODINE, DENISE (RN)
66 YORK STREET APT. 12
LAMBERTVILLE, NJ 08530

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2011
BOEHM, GREGORY (MD)
26777 LORAIN AVENUE, SUITE 716
NORTH OLMSTEAD, OH 44070

NPI-1972678894
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
BOGUSLAVSKIY, VADIM
1903 MADALINE DRIVE
AVENEL, NJ 07001

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2001
A&B INVALID COACH, INC.
655 AMBOY AVENUE
WOODBRIDGE, NJ 07095

BOGUSLAVSKIY, VADIM OWNER
1903 MADALINE DRIVE
AVENEL, NJ 07001

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/25/2002 Permanent
BOHDAN, IWASKO

,

NPI-
Construction
Other
Disqualification

Treasury
Treasury Property Management and Construction

7/23/2018
BOHRER, ARTHUR
13796 RIVOLI DRIVE
W. PALM BEACH, FL 33410

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/17/2000
BOHUSLAWSKY, NINA (RN)
P.O. BOX 4004
CLINTON, NJ 08809

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2010
BOISVERT, RAYMOND JOHN (RN)
2701 NW 23 BLVD, APT 225
GAINESVILLE, FL 32605

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015
BOND, CLIFTON (MD)
418 JAMESTOWN COURT
MT LAUREL, NJ 08054

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

2/21/1992 Permanent
BONDAR, SOFIYA (DDS)
2815 COYLE ST. APT 210
BROOKLYN, NY 11235

NPI-1952355158
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2011
BONETT, OLGA
5105 N. PARK DRIVE
PENNSAUKEN, NJ 08109

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2003
BONILLA, CLEMY (CHHA)
2809 YORKSHIP ROAD
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
BONNELL, STEPHANIE (RN)
165 DEY GROVE RD
MONROE, NJ 08831

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
BONSU, ACHIAA (CHHA)
1414 BIRCHWOOD COURT
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 3/3/2020
BONSU, KWADWO (CHHA)
911 AZALEA DRIVE
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BONSU, NANA (CHHA)
68 MYRTLE AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2018
BOODRAM, VERONA
134 EVERGREEN PLACE 8TH
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/22/2006
BOONE, LESLIE (RN)
122 SUMMIT AVENUE
TRENTON, NJ 08628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2002
BOOS, GEORGE (PRESIDENT)
551 STANTON AVENUE
FRANKLINVILLE, NJ 08322

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/25/2011 11/24/2014
BORCHARDT, KAREN (RN)
4145 MILL CREEK DRIVE
N. CHARLESTON, SC 29420

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/17/2004
BORGES, JOHN MANUEL
550 BUCKINGHAM DRIVE
PISCATAWAY, NJ 08854

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2010
BORNHOLDT, HAE SUK (THERAPIST)
P. O. BOX 1288
MCAFEE, NJ

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
BORNSTEIN, KATHLEEN (LPN)
136 73RD STREET
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
BOROWEC, LAWRENCE W. (MD)
202 STATESBURG AVENUE
NEWFIELD, NJ 08344

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/18/1997 12/1/1998
BOROWEC, LAWRENCE W. (MD)
202 STOTESBURY AVENUE
NEWFIELD, NJ 08344

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
BORRELLI, HENRY (DPM)
49 PROSPECT STREET
LITTLE FALLS, NJ 07424

NPI-1902839830
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

4/6/2010 10/27/2017
BORTZ, AMANDA (PHARM TECH)
13 SWEET BRIAR DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016 4/5/2018
BOSTICK, MICHELLE (CHHA)
87 TILLINGHAST STREET
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
BOTTENBLEY, CECIL J. (DMD)
16 FIRESIDE CT.
WILLINGBORO, NJ 08046

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/9/1987 Permanent
BOUCHE, JASON
6641 E. MEADOWLARK LANE
PARADISE VALLEY, AZ 85253

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2012
BOULOS-PLUDOWSKI, GEORGEANN (RPH)
493 RINGWOOD AVENUE
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005 3/11/2013
BOWICK, JUDY C. (CHHA)
1503 BOND STREET
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2002
BOYD, DARRYL
PO BOX 38, FCI
FORT DIX, NJ 08640

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2002
BOYKIN, ASHLEE (CHHA)
602 HARBOR LANE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2018
BOYKINS, TAMIKA (CHHA)
235 ABLETT VILLAGE
CAMDEN, NJ 08105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/16/2018
BRABHAM, THEODORE J.
14 HAZARD STREET
ELIZABETH, NJ 07208

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2001 Permanent
BRACCIA, VITO, PRESIDENT
184 FAIRWAY ROAD
AMBLER, PA 19002

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/27/2012 7/26/2015
BRACUTO, ANNMARIE (RN)
1319 ST. GEORGE AVENUE
RAHWAY, NJ 07065

NPI-
Medical
Wage & Hour Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
Brothers LandscapingJ.H. Brothers Inc.
169 Robertsville Rd.
Freehold, NJ 07728

Brad J. Moini, President
101 Buttonwood Lane
Freehold, NJ 07728

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/6/2015 01/05/2018
BRADLEY, EARL B. (MD)
1181 PADDOCK ROAD
SMYRNA, DE 19977

NPI-1669414553
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2012
BRANCO, DOROTHY (LPN)
1012 W. GENEVA STREET
EGG HARBOR CITY, NJ 08215

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2019
BRANDT, DOUGLAS A.
5 HOWARD STREET
VERONA, NJ 07044

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2011
BRANDT, HERBERT L. (RPH)
6 DEVONSHIRE DRIVE
RANDOLPH, NJ 07689

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2011
BRANDT, JEFFREY M.
24 CRESTVIEW LANE
MOUNT ARLINGTON, NJ 07856

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/17/2011
BRAUNSTEIN, MOSES
2404 BRONX PARKWAY
BRONX, NY 10458

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
BRAVER, ALEXANDER (MD)
127 CROAK AVENUE
STATEN ISLAND, NY 10314

NPI-1811098650
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2007
BREEN, NICHOLAS (DMD)
7731 RUDDEROW AVENUE
PENNSAUKEN, NJ 08109

NPI-1730307836
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/18/1995 9/27/2013
BREEN, NICHOLAS (DMD)
7731 RUDDEROW AVENUE
PENNSAUKEN, NJ 08109

NPI-1730307836
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/14/1996 9/27/2013
BREIHOF, PETER
51 COEYMAN AVENUE
NUTLEY, NJ 07110

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2019
BRESSMAN, DANIELLE (RN)
40 HARBORAGE AVENUE
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2019
BRETTLER, NORBERT AKA BRETTLER, NORMAN
401 COUNTRY CLUB DRIVE
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
BREWINGTON, CYNTHIA (CHHA)
379 MILLBRIDGE ROAD
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
American Welding ServicesAmerican Welding Services, Inc.
1041 Glassboro Rd D-2
Williamstown, NJ 08094

Brian O'Shea, Owner
1041 Glassboro Rd D-2
Williamstown, NJ 08094

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/10/2014 07/09/2017
Brian Patterson Mechanical Contracting, Inc.
5 Cindy Lane
Ocean, NJ 07712

Brian Patterson, President
11 Arlene Drive
West Long Branch, NJ 07764

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/30/2015 03/29/2018
BRICK, ROGER (MD)
31-33 WEST 11TH STREET
NEW YORK, NY 10026

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/15/2006
AMERICAN MEDICAL SVCS. PC
1 ALPHA AVENUE
VOORHEES, NJ 08043

BRIGHAM, STEVEN C. (MD)
1 ALPHA AVENUE
VOORHEES, NJ 08043

NPI-1306012539

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
BRINT, SAMUEL (DO)
515 BROADWAY
CAMDEN, NJ 08103

NPI-1538326780
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/15/1987 Permanent
BRISTOL, KENNETH (RN)
PO BOX 931
FLAGSTAFF, AZ 06002

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
BRITT, JANICE (RN)
28 SCHOOL STREET
SWANSEA, MA 02777

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/27/2019
BRIZER, DAVID ALLEN (MD)
6766 108TH STREET, APT A62
FOREST HILLS, NY 11375

NPI-1518181270
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2015
BRIZER, DAVID ALLEN (MD)
255 W 85TH STREET, APT 5B
NEW YORK, NY 10024

NPI-1518181270
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/2014
BROADNAX, DEITRICH
347 BELLEVILLE AV, #B8
BLOOMFIELD, NJ 07003

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/25/1998 Permanent
BRODSKY, KONSTANTIN (CHHA)
55 WEST 45TH STREET, FLOOR 7R
NEW YORK, NY 10036

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/2/2017
BROOKHIM, ROBEN (DDS)
120 LAWRENCE DRIVE
SHORT HILLS, NJ 07078

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
BROOKHIM, ROBEN (DDS)
444 MORRIS AVENUE
ELIZABETH, NJ 07208

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2000
BROOKMAN, HARVEY (MD)
301 OXFORD VALLEY ROAD
YARDLEY, PA

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/13/1995
BROOKS JR., OSCAR (COUNSELOR)
27 E VILLAGE OF STONEY RD
MAPLE SHAE, NJ 08052

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/1995 Permanent
BROOKS, MAUREEN R. (LPN)
110 THIRD AVENUE
BELMAR, NJ 07719

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/9/2003
BROWN, ALEXANDRIA N. (RN)
803 DAWN LANE
WILLIAMSTOWN, NJ 08094

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
BROWN, DANNY (CHHA)
527 CENTRE STREET
EASTON, PA 18042

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/6/2018 Permanent
BROWN, DEANNA (CHHA)
611 B. BINGHAM STREET
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
BROWN, DERVENT (CHHA)
151 FIRST STREET
ENGELWOOD, NJ 07631

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/26/2018
BROWN, IMAN (CHHA)
717 N. MICHIGAN AVENUE
ATLANTIC CITY, NJ 08401

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/14/2017
BROWN, KAYDIA (CHHA)
1033 SEWALL AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BROWN, LAFONDA (CHHA)
485 EAST 19TH STREET, APT. #4-F
PATERSON, NJ 07524

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/26/2017
BROWN, ROGER H. (DMD)
601 ROUTE 206, UNIT 30
BELLE MEAD, NJ 08844

NPI-1457460305
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/27/2005
BROWN, SAO (LPN)
9 ALAN STREET
WEST ORANGE, NJ 07052

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/5/2017
BROWN-COLEY, KELLI (LPN)
88 WEST 6TH STREET
BAYONNE, NJ 07002

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/11/2017
BRUNELLE, ELIZABETH (LPN)
5902 EAST 2ND STREET
TUCSON, AZ 85711

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
BRYANT SR., DAVID V.
107 MADISON ROAD
PITTSGROVE, NJ 08344

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
Criminal Justice

9/13/2013 9/12/2018
GULF COAST POLYMER SERVICES, INC.

,

BRYANT, GERALD
4984 LAKE ROAD
NEWFIELD, NJ 08344

NPI-

Vendor
Criminal Offense
Debarment

Law and Public Safety
Criminal Justice

9/13/2013 9/12/2018
BRYANT-DERRICK, KISHARA (LPN)
107 DEAL AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
BUCKLER, BERT L., PRESIDENT
182 WYCOFF WAY WEST
EAST BRUNSWICK, NJ 08816

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/3/2013 1/2/2016
BUCKLEY, MARIANNE (LPN)
83 IRVING COURT
TRENTON, NJ 08610

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
BUITRAGO, CARMEN (LPN)
412 CLIFF STREET, APT. 1
FAIRVIEW, NJ 07022

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/12/2018
BULGER, PATRICE (RN)
117 MILL CREEK ROAD
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/15/2002
BULLARD, ANGELA (CHHA)
268 E. 21ST STREET, 3RD FLOOR
PATERSON, NJ 07513

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2017
BUNCH, LATITIA (LPN)
212 S. 27TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
BUNN, YAHMINAH (CHHA)
22 GATLING COURT
NEW BRUNSWICK, NJ 08901

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
BUONO, DONNA (RN)
61 S. LOCUST AVE
MARLTON, NJ 08053

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
BURDETTE, KAYLA F. (CHHA)
31 ISLAND AVENUE
SEASIDE PARK, NJ 08752

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/14/2014
BURGOS, LEALYNN (CHHA)
636 BILLINGS AVENUE
PAULSBORO, NJ 08066

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BURKARD, JUDITH (LPN)
320 7TH AVENUE APT 16
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2009 11/23/2010
BURKE, WILLIAM (MD)
PO BOX 670
NEW VERNON, NJ 07976

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
BURKES, JEFFREY (DDS)
176 LAKEWOOD AVENUE
HO-HO-KUS, NJ 07423

NPI-1073690137
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/19/2009
BURKETT, EILEEN (PHARM TECH)
1407 VIRGINIA COURT
MARLTON, NJ 08053

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2011
BURNETT, RASHEEDAH (CHHA)
860 SOUTH 11TH STREET, APT. 4-B
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
BURNS, MARGARET
2429 WESTFIELD AVENUE
SCOTCH PLAINS, NJ 07076

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
BURRELL, TIARA (CHHA)
141 STRANGER AVENUE
GLASSBORO, NJ 08028

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2019
BURWELL-ADENIJI, LORIN (CHHA)
1004 HIGH STREET
BURLINGTON, NJ 08016

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
BUSSEY, PAUL (MD)
187 KIRSCHLING DRIVE
SWEDESBORO, NJ 08095

NPI-1356341424
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/22/2016
BUSSEY, PAUL (MD)
1 MILL STREET
WOODSTOWN, NJ 08098

NPI-1356341424
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/13/2015
BUTT, ATIQ (PRESIDENT)
2524 FORD ROAD
BRISTOL, PA 19007

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2001 Permanent
BUTTERHOF, TRACY (RN)
501 S. BERLIN AVE.
EGG HARBOR CITY, NJ 08215

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
BUTTS, YOLANDA (CNA)
600 PACIFIC AVENUE, APT. A102
ATLANTIC CITY, NJ 08401

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/2/2020
BYADGI, CHETHAN (MD)
LACKAWANNA COUNTY PRISON, 1371 NORTH WASHINGTON AVENUE
SCRANTON, PA 18509

NPI-1063537215
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
BYAHATTI, PRAMILA (MD)
200 EXCHANGE STREET, UNIT 217
PROVIDENCE, RI 02903

NPI-1841212800
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/23/2020
R & B MEDICAL TRANSPORTATION
844 JEROME AVENUE
HILLSIDE, NJ 07205-3108

BYERS, FAYE AKA BYERS, RAYMOND
844 JEROME AVENUE
HILLSIDE , NJ 07205

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/14/2005
CABALEIRO, YODALIO (MD)
3700 KENNEDY BLVD.
UNION CITY, NJ 07087

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/1986 Permanent
CABALERIO, THERESA
4611 BERGENLINE AVE.
UNION CITY, NJ 07087

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
CABAN, DESTINY (CHHA)
105 BOYD STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
CABATIC, VIRGINIA C. (RN)
14 SPARROW ROAD
RANDOLPH, NJ 07869

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
CABRERA, RAMON BRETON
486 ZAMBORY STREET, APT.
PERTH AMBOY, NJ 08861

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/19/2011
CACERES, MARIO
328 MARKET STREET
CAMDEN, NJ 08102

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/1998
NEW HOPES OF NJ, INC.
328 MARKET STREET
CAMDEN, NJ 08102

CACERES, MARIO ( CO-OWNER)
328 MARKET STREET
CAMDEN, NJ 08102

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/5/2000
CACI, FRANCIS R. (DDS)
248 SOUTH SUMMIT AVENUE
HACKENSACK, NJ 07601

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

12/8/1997 DECEASED
CACOILO, MARIA (OFF. MGR.)
1150 AMBOY AVENUE
EDISON, NJ 08837

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/29/2003
CAI, PING (DMD)
22 SAGE STREET
HOLMDEL, NJ 07733

NPI-1275667362
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/10/2012 9/15/2017
CALABRESE, ANGELO (MD)
FCI-SCHUYLKILL, PO BOX 759
MINERSVILLE, PA 17954

NPI-1891722237
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/22/2016
CALABRESE, ANTHONY (RN)
105 JOAN COURT
JACKSON, NJ 08527

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/22/2020
CALDERON, TANISHA (CHHA)
108 N. 16TH
EAST ORANGE, NJ

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
CALLAHAN, VICTORIA (PHARM TECH)
130 FROST AVENUE
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/21/2017 Permanent
CALVELO, ARSENIO C. (RN)
13515 SCENIC GLADE DR.
HOUSTON , TX 77059

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
Calvin's Floor Service,aka Calvin's Carpet Service
126 Winding Ridge Road
Dover, DE 19904

Calvin Hudson, Owner
126 Winding Ridge Road
Dover, DE 19904

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/12/2013 06/11/2016
CAMACHO, OLGA (CHHA)
176 KNAPP AVENUE
CLIFTON, NJ 07011

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/2018
CAMP, SUZANNE (RN)
P.O. BOX 423
PORT ELIZABETH, NJ 08348

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/21/2010
CAMPANELLA, ANDRE, V. PRESIDENT
948 SINCLAIR AVE
STATEN ISLAND, NY 10309

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/7/2013 2/6/2016
CAMPANELLA,-KAPLAN, DONNA (LPN)
1355 W. POINT AVENUE
MAYS LANDING, NJ 08330

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/10/2018
CAMPBELL JR., HIGHLAND (MD)
1009 MEADOWVIEW LANE
MONT CLARE, PA 19453

NPI-1043270143
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015 12/18/2020
CAMPIONE JR., FRANK (PA)
431 STONEY POINT ROAD
BRICK, NJ 08733

NPI-1598856924
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2016 2/19/2020
CANALES JR., DELOVI
11 ALBERT STREET
TOMS RIVER, NJ 08953

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/30/2010 4/30/2013
CANARES, ALEXANDER (RN)
60 RBOOKSIDE AVENUE, APT. 2-B
SOMERVILLE, NJ 08876

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2018
CANE, LAMONT (NURSES AIDE)
P.O. BOX 90431
CAMDEN, NJ 08012

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/18/1997
CANNON, JEROME
4221 NORTH 6TH STREET
PHILADELPHIA, PA 19140

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
CANTAVE, MARIE (CHHA)
1217 OCEAN AVENUE, APT. C-12
BRADLEY BEACH, NJ 07720

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2017
CANTERMEN, LYNN (RN)
518 N. HILDEBRAND AVENUE
GLENDORA, NJ 08029

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2018
CAPACIO, RICHARD (DC)
99 ANNAPOLIS DRIVE
SICKLERVILLE, NJ 08081

NPI-1245230929
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006
CAPILLI, MICHAEL A. (DC)
427 HOYT STREET
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/9/2001
CAPITANO, PETER (RPH)
SCHUYLKILL FCI, PO BOX 759
MINERSVILLE, PA 17954

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
CAPO, LASARAH (CHHA)
50-52 ROSA PARK BOULEVARD, APT. 5
PATERSON, NJ 07501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
CAPOBIANCO, LEO J. (DO)
7 CASTLE COURT
RANDOLPH, NJ 07860

NPI-1063483097
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/5/2002 6/8/2018
CAPPIELLO, RAFAEL (MD)
2704 BRIENZA WAY
LAS VEGAS, NV 89117

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/19/1999 Permanent
CAPRIOLA, EDWARD (MD)
313 S. FRANK ROGERS
HARRISON, NJ 07029

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006 DECEASED
CARABALLO, CARLA (CHHA)
742 EAST SEVENTH STREET
PLAINFIELD, NJ 07062

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/13/2017 Permanent
CARAGINE JR., PAUL J. (MD)
1 SAWMILL ROAD
KINNELON, NJ 07504

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
CARCHIA, ETTORE (DC)
994 SANDY CIRCLE
MANAHAWKIN, NJ 08050

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2006
CARDENAS, PRESENTACION E. (RN/LPN)
274 BATH AVE., #22
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
CARDILLO, JOHN
162 GARFIELD STREET
BERKELEY HEIGHT, NJ 07922

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2006
CARDILLO, JOHN
162 GARFIELD STEET
BERKELEY HEIGHT, NJ 07922

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/4/2005
CARDILLO, RICHARD C. (MD)
2893 BIRCH ROAD
SUAMICO, WI 54173

NPI-1477520807
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/27/2002
CARDINAL, PETER (MD)
520 WALNUT STREET, APT. 3
LEMOYNE, PA 17043

NPI-1104985142
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
CARDOSO SR., LUCIO (MD)
FCI FORT DIX
FORT DIX, NJ 08640

NPI-1639119019
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/3/2014
CARDOSO SR., LUCIO (MD)
253 LAFAYETTE STREET
NEWARK, NJ 07105

NPI-1639119019
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012
CAREY JR., CHARLES B.
218 BRIANT PARK DRIVE
SPRINGFIELD, NJ 07081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
CARIDAD, MICHELLE (CHHA)
10 BROOKSIDE COURT
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
CARIDEO, IDA (MD)
7 MALKE DRIVE
WAYSIDE, NJ 07712

NPI-1578842977
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/7/1999 8/1/2012
CARINO, JOVY
37 JAMES STREET
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/29/2009
CARLSON, LILLIAN MAE (RN)
275 HIGH STREET APT. Q334
GLASSBORO, NJ 08028

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/18/2009
CARLUCCI JR., WILLIAM A (RPH)
FCI FORT DIX
FORT DIX, NJ 08640

NPI-1902120363
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/25/2014
CARLUCCI, ROBERT A. (RPH)
PO BOX 759
MINERSVILLE, PA 17954

NPI-1639493091
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/25/2014 Permanent
CARMENATY, ANTHONY (LPN)
28 SUMMER STREET
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2019
CARMONA, ALICE Y.
78 DAWN STREET
VINELAND, NJ 08302

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/23/2000 Permanent
CARR, JOEL R. (DO)
8 JASMINE ROAD
LUMBERTON, NJ 08048

NPI-1275586489
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/2/2011
CARR, PATRICIA
P.O. BOX 91
BROWNS MILLS, NJ 08015

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001
CARRION, NANCY (CHHA)
76 ZABRISKIE STREET
JERSEY CITY, NJ 07307

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/5/2018
CARRION, SARAH (CHHA)
1086 KENYON AVENUE
PLAINFIELD, NJ 07060

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/9/2018
CARROLL, KIMBERLY J. (LPN)
18 LEE AVENUE
HADDOMFIELD, NJ 08033

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/18/2011
CARSON, YOLANDA (CHHA)
65 DALES AVENUE, APT. 1137
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
CARTER, DARRICKA C. (DPM)
2505 ST. REGIS DRIVE
RICHMOND, VA 23236

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2010
CARUSO, EDMUND M. (DMD)
2275 KENNEDY BLVD.
JERSEY CITY, NJ 07304

NPI-1811132442
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/10/1994 Permanent
CASAS, JOSE (MD)
215 PASSAIC AVENUE
PASSAIC, NJ 07055

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/24/1999 Permanent
CASAVINA, PHILIP
244 KNOX AVENUE
CLIFFSIDE PARK, NJ 07650

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
CASCIO, DANIEL (RN)
17 SEGUR STREET
DOVER, NJ 07801

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2002
CASTANEDA, JOSE (APN)
194 E. 7TH STREET
CLIFTON, NJ 07011

NPI-1699840264
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/26/2015
CASTANEDA, JOSE (APN)
1925 PACIFIC AVENUE
ATLANTIC CITY, NJ 08401

NPI-1699840264
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012
CASTANON, ROBERTO
555 GEO DRIVE
PHILLIPSBURG, PA 16866

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2011
PASSAIC FAMILY MEDICAL
540 BROADWAY
PASSAIC, NJ 07055

CASTELLANO, DOLORES (OWNER)
4300 SW 57TH STREET
MIAMI, FL 33155

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/17/2004 Permanent
CASTILLO, AL JEHDD (CHHA)
170 32ND STREET WEST
BAYONNE, NJ 07002

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2018
CASTILLO, HECTOR L. (MD)
1000 MADISON AVENUE
PATERSON, NJ 07501

NPI-1528198124
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

2/19/2012
CASTILLO, STEVEN A. (DDS)
P.O. BOX 16421
JERSEY CITY, NJ 07306

NPI-1134342017
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/5/1997 Permanent
CATANIA, RAYMOND (DO)
5 BRIARWOOD DRIVE EAST
WARREN, NJ 07059

NPI-1023094711
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/16/2021
CATANZARO, DANIEL (DC)
28 ETOWAH RIDGE DRIVE, SW
CARTERSVILLE, GA 30120

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2005
CATANZARO, VINCENT F. (MD)
560 MAIN STREET
ALLENHURST, NJ 07711

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
CATHERS, THOMAS (LPN)
707 BURLINGTON AVENUE
DELANCO, NJ 08075

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/6/2019
CAVALLARO, KEVIN (RN)
630 SALEM AVENUE
FRANKLINVILLE, NJ 08322

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2019 Permanent
CAVALLI, DEAN
762 BROADWAY
CAMDEN, NJ 08103

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
CAVE, SANDY
109 BOBWHITE ROAD
ROYAL PALM BEACH, FL 33411

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2012
CECE, ANGELO (DMD)
566 NYE AVENUE
IRVINGTON, NJ 07111

NPI-1033396593
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/19/1996 Permanent
CEDENO, HUMBERTO (RPH)
601 ELIZABETH AVENUE
ELIZABETH, NJ 07206

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/3/1984 Permanent
CENTRELLI, MARC (DC)
176 ALPINE TRAIL
SPARTA, NJ 07871

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/21/2008
CERELLI NICK (MEMBER)
1640 NIXON DR., STE. 285
MOORESTOWN, NJ

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/6/2013 2/5/2016
Demanual Drywall Services, Inc.
64 Grandview Ave
North Plainfield, NJ 07060

Cesar Garcia, Owner
64 Grandview Ave
North Plainfield, NJ 07060

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/1/2014 04/30/2017
CHA, DONG S. (MD)
608 S. BROAD STREET
WOODBURY, NJ 08096

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
CHACK, JOEL (DO)
5 GWEN COURT
CHERRY HILL, NJ 08003

NPI-1093739096
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/13/2011 1/6/2012
CHACKER, JASON (PA)
1030 DOMINO LANE
WARMINSTER, PA 18974

NPI-1609058916
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2020
CHAI, CHRISTINA (RPH)
2561 LEIGHTON STREET
FORT LEE, NJ 07024

NPI-1689997835
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2016
CHAIKEN, BARBARA (LCSW)
419 OTISCO DRIVE
WESTFIELD, NJ 07090

NPI-1871768465
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
RADIATION ONCOLOGY GROUP
100 FORD ROAD
DENVILLE, NJ 07107

CHAM, WILLIAM C. (MD)
11 HICKORY DRIVE
CHESTER TWP, NJ 07930

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/29/1997
CHAMBERS, CAROL (CHHA)
1022 STUYVESANT AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2004
CHAMPION, MARY MARGARET (RN/CHHA)
91 MOUNT AIRY AVE., SOUTH
EGG HARBOR, NJ 08234

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005 6/11/2013
CHANDLER, BRYAN K.
10 ELLINGTON STREET #1
EAST ORANGE, NJ 07017

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2008
CHANDLER, CHARLES
219 N. WALNUT STREET, FL. 1
EAST ORANGE, NJ 07017

NPI-1417996901
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/4/2009
Chaney, James
610 County Meadows Road
Nicholls, GA 31553

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/11/2015 8/10/2018
CHANSKY, CHRISTINE (MD)
820 NORTH AVENUE
WESTFIELD, NJ 07090

NPI-1508125600
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/20/2018
CHAPLAN, ABRAHAM (MD)
384 NORTH WOODLAND ST.
ENGLEWOOD, NJ 07631

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
All Jersey Fence Co.
266 Columbus Ave
Hasbrouck Heights, NJ 07604

Charles Viola, President
10 Route 46 West
Clifton, NJ 07011

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/15/2016 9/14/2019
CHARLES, ERIC
396 CHERRY LANE
MENDHAM, NJ 07945

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/22/2014 4/21/2017
CHARLES, ESTHER (CHHA)
380 UNION AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
CHATMON, ALTON (RPH)
RR8, BOX 370
BRIDGETON, NJ 08302

NPI-1790091742
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/3/2017
CHAUDHRY, YASMIN (OWNER)
333 NORTH BROAD STREET
ELIZABETH, NJ 07028

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/21/1997
CHEESE, EPHONIA (CHHA)
18 PATRIOT LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/16/2018
CHEN, BONNIE (MD)
243 HORSENECK ROAD
FAIRFIELD, NJ 07004

NPI-1750373486
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/12/2018 Permanent
CHEN, KENNETH (MD)
244 BROADWAY
NEWARK, NJ 07104

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/7/1999
CHEN, TAN (MD)
12 LORRAINE DRIVE
PINE BROOK, NJ 07058

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/5/1999 Permanent
CHERVIN, ARON
36 LAKE DRIVE
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
Cheryl Apgar, Vice-President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2016 2/10/2019
CHESTON, EBONY (CHHA)
33 NEWELL AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
CHHADEH, AHED
401 NEW BRUNSWICK AVENUE, APT. 221
EAST BRUNSWICK, NJ 08816

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
CHIAPETTA, THERESA
8 STEINHARDT AVENUE
OLD BRIDGE, NJ 08857

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/15/2008
CHIAPETTA, THERESA
8 STEINHARDT AVENUE
OLD BRIDGE, NJ 08857

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/12/2009
CHICCO, LUKE #65503-050
FCI FAIRTON, PO BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2019
CHIKOWSKI, JOHN (RN)
121 WEST 29TH STREET, 2ND FLOOR
BAYONNE, NJ 07002

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/24/2018 4/9/2019
CHILLEMI, SALVATORE
29 BERKSHIRE DRIVE
SEWELL, NJ 08080

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/10/2011
CHIRUMAMILLA, RAMABU (RPH)
212 E PITTSBURGH AVENUE
WILDWOOD CREST, NJ 08260

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/1985 Permanent
CHIZHOV, ELLA
200 WINSTON DRIVE #C1104
CLIFFSIDE PARK, NJ 07010

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/21/2008
CHIZHOV, SERGEY
200 WINSTON DRIVE
CLIFFSIDE PARK, NJ 07010

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2007
CHLOROS, STACY (LPN)
323 GILL LANE
ISELIN, NJ 08830

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/18/2006
CHOI, JEHEE (RN)
31 PINE RIDGE LANE
MANSFIELD CENTER, CT 06250

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2018
CHRISTENSEN, CYNTHIA (RN)
20 SKYLINE DRIVE
HAZLET, NJ 07730

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
Christine Charles, Vice-President
396 Cherry Ln
Mendham, NJ 07945

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/22/2014 04/21/2017
CHRISTJOHN, COLLEEN M. (LPN)
144 CORSON TAVERN ROAD
SOUTH SEAVILLE, NJ 08246

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/11/2007 Permanent
CHRISTMAS, ARTHUR
66 NORTH 11TH STREET
NEWARK, NJ 07107

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/16/2006 Permanent
IBS, Inc.
1929 Darby Rd
Havertown, PA 19083

Christopher Rymal, Owner
1929 Darby Rd
Havertown, PA 19083

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/16/2014 05/15/2017
CHRISTPHONTE, CAIRY (CHHA)
1976 OSTWOOD TERRACE
UNION, NJ 07083

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/9/2019 Permanent
CHU, ALICE (MD)
1512 PALISADE AVENUE, APT. 6P
FORT LEE, NJ 07024

NPI-1356505127/1962513366
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/24/2019
CHUDRY, RAZA
RD #5 FEDERAL PRISON
LEWISBURG, PA 17837

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
CHUGH, JAGDISH (MD)
1 CORINE COURT
LONG VALLEY, NJ 07853

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/2/2019
CHUKWUANI, ROSETTA (CHHA)
3 LISZKA LANE
SAYREVILLE, NJ 08872

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/28/2009
CHULAK, GENADY (PRESIDENT)
242 COMMUNIT CIRCLE
OLD BRIDGE, NJ 08857

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/15/1996 Permanent
CHUNMUANG, PRASERT (MD)
401 DEVONSHIRE PL
FRANKLIN LAKES, NJ 07417

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/14/1993 Permanent
CHUPREVICH, EILEEN, D. (RN)
8 STANTON PLACE
BUTLER, NJ 07405

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2003
CIALLELLA, GINA AKA GARCEN, GINA (DC)
57 GREEN STREET
WOODBRIDGE, NJ 07095

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2000 Permanent
CICCONE, GREGORY
5 WATERS EDGE DR.
LITTLE EGG HARB, NJ 08087

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/15/2005
CICERO, BARBARA (RN)
91 LINCOLN AVENUE
SOMERVILLE, NJ 08876

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2001
CICERO, RALPH (DDS)
245 BALDWIN STREET
SUCCASUNNA, NJ 07876

NPI-1740449305
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2014
CICERON, ANDRE (MD)
621 BANNING AVENUE
NORTHFIELD, NJ 08225

NPI-1265526586
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2019 Permanent
CLACKLEY, MACK O. (LPN)
PO BOX 150
DELMONT, NJ 08314

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2001
CLAPPER, STEPHANIE (LPN)
169 NAUTILUS
MANAHAWKIN, NJ 08050

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2010
CLARK, JAMES
380 MOUNTAIN ROAD #12
UNION CITY, NJ 07087

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/27/2007
CLARK, INDIA (CHHA)
55 SECOND AVENUE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 5/6/2021
CLARK, JOVONNE (CHHA)
1605 SEWALL AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/22/2017
CLARK, KEVIN
537 TRINITY PLACE
WESTFIELD, NJ 07090

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/5/2009
CLARK, NORMAN L. (MD)
5 TARA DRIVE
PARSIPPANY, NJ 07054

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/2/1999
CLARK, RAYONNE
844 CENTRE STREET
TRENTON, NJ 08611

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/13/2003
CLARK, RAYONNE
844 CENTRE STREET
TRENTON, NJ 08611

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2003
CLARK. NYKEBA (CHHA)
807 N. INDIANA AVENUE
ATLANTIC CITY, NJ 08401

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/24/2018
CLARKE, KIRK (CHHA)
218 YOUNGS ROAD
TRENTON, NJ 08619

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/30/2019 Permanent
CLARKE, MICHELLE (CHHA)
75 NORTH WALNUT STREET, APT. 6C
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/30/2017 Permanent
CLAVIJO, LAURA
908 CLARK CIRCLE
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
CLEMENTE, JOHN (MD)
20 PILGRIM WAY
COLTS NECK, NJ 07722

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/29/2015
CLEMENTE, JOHN (MD)
20 PILGRIM WAY
COLTS NECK, NJ 07722

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2015
CLEMMENTS, RALPH W. (MD)
7304 CENROSE CIRCLE
WESTWOOD, NJ 07675

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/12/2008
COBB, ROY (MD)
504 SUMMIT AVENUE
MAPLEWOOD, NJ 07040

NPI-1548350556
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017 Permanent
COBB, WILLIAM A. (MD)
2 WEST RIVER STYX ROAD
HOPATCONG, NJ 07843

NPI-1679666903
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/16/2011 Permanent
COCCO, KRISTEN
44 SYRACUSE DRIVE
CHERRY HILL, NJ 08056

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
CODDINGTON, DE'LYNNE (CHHA)
904 MAIN STREET
BRADLEY BEACH, NJ 07720

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/8/2017
COHEN, BARRY E.
6326 NW 80TH TERRACE
POMPANO BEACH, FL 33067

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2006
COHEN, JUDAH L. (MD)
1000 GALLOPING HILL RD.
UNION, NJ 07083

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/1998 Permanent
COHEN, ROBERT G. (RN/APN)
51 KRISTEN COURT
MATAWAN, NJ 07747

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2003
COHEN, WENDY E. (MD)
151 N. DEAN STREET
ENGLEWOOD, NJ 07631

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/10/2012 DECEASED
COLADONATO, JOSEPH P. (MD)
9760 EVERGREEN AVENUE
SEAFORD, DE 19973

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/3/2006
COLBERT, DONNA (CHHA)
183 ROUTE 35
WALL TOWNSHIP , NJ 07719

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 Permanent
COLEMAN, BARBARA (CHHA)
81 LINCOLN PARK, APT. 5B
NEWARK, NJ 07102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
COLEMAN, BETH (RN)
12 NORTH ELMIRA STREET
ATHENS, PA 18810

NPI-1598919466
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
COLETTI, ROGER (MD)
324 CAPTAINS CL
LEWES, DE 19958

NPI-1770508053
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/5/2018 Permanent
COLEY, CHERYL (CHHA)
17 NORTH 3RD STREET
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/22/2018
COLLIER, BERT D. (MD)
4933E N. WINDWOOD AVENUE
MILWAUKEE, WI 53217

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/29/2001 9/20/2013
COLLIER, KENYA (CHHA)
708 THIRD AVENUE, APT. 13-B
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
COLLIER, KISHA (CHHA)
54 FEDERAL COURT
GALLOWAY, NJ 08205

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
COLLINS, JEAN (RN)
218 COPELAND AVENUE
LYNDHURST, NJ 07071

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/2018
COLON, KAREN L. (LPN)
1020 MCGUIRE DRIVE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
COLON-TORRES, FRANCIS M.
437 STUYVESANT AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/7/2008
COMESANAS, MARIO (MD)
COLUMBIA TPK.
FLORHAM PARK, NJ 07932

NPI-1508922659
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
COMPAS, JEAN CLAUDE (MD)
255 EASTERN PARKWAY
BROOKLYN, NY 11238

NPI-1720178148
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
COMRIE, SHIRLEY M. (CHHA)
7 DUFFELD DRIVE
TRENTON, NJ 08628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
CONARD, MICHELLE (LPN)
16 ELDRIDGE AVENUE
TRENTON, NJ 08648

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2009
CONDON, MARJORIE (DO)
327 FRANKLIN AVENUE
RIDGEWOOD, NJ 07450

NPI-1528098068
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/2/2019
CONNERS, LAURA (LPN)
11 FENWAY ROAD
HAMILTON, NJ 08620

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
CONOVER, WILLIAM S. (LPN)
225 RUTLAND AVE.
MT. HOLLY, NJ 08060

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
CONTE, SALVATORE (MD)
NEW YORK RRM, PO BOX 329014
BROOKLYN, NY 11232

NPI-1174688493
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
CONTEH, AMARA S. (MD)
3 OLD TAPPAN ROAD
OLD TAPPAN, NJ 07675

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2007
CONTI, VINCENT (MFT)
180 PROSPECT AVENUE
MORRIS PLAINS, NJ 07950

NPI-1023189644
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/2016
CONTRERAS, MICHAEL
77 LITTLETON RD
MORRIS PLAINS, NJ 07950

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/12/2013 4/11/2016
COPLIN, GEORGE J. (MD)
528 EAST JERSEY ST
ELIZABETH, NJ 07206

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
COPPOLA, KELLY AKA FURLONG, KELLY (PHARM TECH)
52 CORNELL DRIVE
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/2016
CORNELY, MICHAEL P. (DC)
6650 BROWINING ROAD
MERCHANTVILLE, NJ 08109

NPI-1326199803
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
CORREA-HUNTER, LOUISA (DDS)
372 FOREST AVENUE
PARAMUS, NJ 07652

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/22/2010
CORSON KENNETH E. (MD)
5 SOUTH MYRTLE ST
VINELAND, NJ 08360

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

DECEASED Permanent
CORTEZ, JESSICA (CHHA)
114 EDWARDS AVENUE
LANDISVILLE, NJ 08326

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/6/2017
COSTA, LAWRENCE J.
441 PENN AVE.
FORKED RIVER, NJ 08731

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
COSTA, PAULA, PRESIDENT
33 E. KUPSCH STREET
SAYREVILLE, NJ 07032

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/19/2012 1/18/2015
COSTIGAN, KEVIN (LCSW)
132 FRANKLIN AVE, APT. 2
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/21/2000
COSTINO JR., JOHN (DO)
404 SURF AVENUE
WILDWOOD, NJ 08260

NPI-1811978414
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/18/2011
COTTRELL, LISA L. (CHHA)
290 ROUTE 9 NORTH APT C5
WARETOWN, NJ 08758

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2010
COUCH, SUSAN (CHHA)
10 PLACID LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
COUGHLIN, CATHERINE K. (RN)
PO BOX 22
LIMESTONE, PA 16234

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/18/2009
COULTON, DIANE (LPN)
272 BIRCH DRIVE
LEVITTOWN, PA 19054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/13/2018
COVERDALE, JULIE ANN (RN)
909 CINNAMINSON AVE.
PALMYRA, NJ 08065

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
COVILLE, FREDERICK A. (MD)
230 N. MAPLE AVENUE
MARLTON, NJ 08050

NPI-1679728307
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/17/1997 8/16/2012
COVILLE, FREDERICK A. (MD)
51-37 HAVEN AVENUE
OCEAN CITY, NJ 08226

NPI-1679728307
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/26/1998 8/16/2012
COVONE, DOMINICK (DME OWN)
FORT DIX F.C.I. BOX 38
FORT DIX, NJ 08640

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2001 Permanent
COWAN JR., JAMES (MD)
572 WEST SADDLE RIVER ROAD
RIDGEWOOD, NJ 07450

NPI-1063527026
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2016 Permanent
COWAN JR., JAMES (MD)
28 W. 3RD STREET, APT. 1347
SOUTH ORANGE, NJ 07079

NPI-1063527026
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/6/2017 Permanent
COWAN, MARYANNE (LCSW)
572 WEST SADDLE RIVER ROAD
RIDGEWOOD, NJ 07450

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/21/2016 DECEASED
COWINS, KIMBLINS (CHHA)
75 SHADY LANE
HAMBURG, NJ 07419

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2019 Permanent
COWINS, KIMBLINS (LPN)
75 SHADY LANE
HAMBURG, NJ 07419

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2019
CRAIN, GREGORY
60 HAWKINS ROAD
TABERNACLE, NJ 08088

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001
CRAPANZANO SR., PETER (DDS)
46 VILLAGE COURT
HAZLET, NJ 07730

NPI-1861566960
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/26/2011
CRAWFORD, KENNETH (CNA)
B-8 ABBINGTON DRIVE
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/6/2006
CRAWFORD, KENNETH (CNA)
199A FIDDLER ELBOW ROAD
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2006
CRAY, JASON E. (COTT. AID)
WARREN COUNTY JAIL
BELVIDERE, NJ 07823

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/21/2000 Permanent
CRESTA, NICOLE AKA RIVERA, NICOLE (RN)
2009 KICKAPOO TERRACE
VINELAND, NJ 08361

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
CREWS, VERN (DIRECTOR)
844 N. MAIN STREET
AKRON, OH 44310

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/5/2013 4/4/2016
CRIDER, STEVEN
507 PRESSLER STREET
AUSTIN, TX 78703

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/11/2014 5/10/2017
CRISCITO, MARIO (MD)
32 CHELSEA DRIVE
LIVINGSTON, NJ 07039

NPI-1063411957
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/1/2017 Permanent
CRISSIEN, CINDY
78 FORNELIOUS AVENUE
CLIFTON, NJ 07013

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/18/2007
CRITCHFIELD, CYNTHIA AKA SULLIVAN, CYNTHIA (RPH)
PIN OAK COURT
SHAMONG, NJ 08088

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2008 6/15/2017
CROCKER JR., KENNETH W.
15 VIOLA AVENUE
LEONARDO, NJ 07737

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2009 7/17/2014
CROMARTIE, CHERISE (CHHA)
25 RONALD ROAD
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/19/2018
CRON, EVA (RN)
31 CHERRY STREET
WARWICK, NY 10990

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/27/2007
CROUSE, FARRELL R. (MD)
101 NORTH MAIN STREET
WOODSTOWN, NJ 08098

NPI-1386795292
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/18/2015
CROWDER, CLAXTON L. (MD)
115 ASHBY COURT
MOUNT LAUREL, NJ 08054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/13/2006
CROWLEY, TERRI (RN)
5 THOREAU ROAD
HAMILTON SQUARE, NJ 08690

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/13/2017
CRUCIANI, RICARDO (MD)
77 HUDSON STREET, APT. 4401
JERSEY CITY, NJ 07302

NPI-1881615268
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/16/2018 Permanent
CRUZ, ANGELICA (CHHA)
2566 SOUTH 8TH STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
CRUZ, DELIA (CHHA)
3 RAY PLACE
FAIRFIELD, NJ 07004

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/5/2018
CRUZ, EDNA (CHHA)
PO BOX 535
VINELAND, NJ 08362

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
CRUZ, JAHAIRA (CHHA)
559 BAILEY STREET
CAMDEN, NJ 08102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
CRUZ, MARIA C.
128-65 MCCARTHY CIRCLE
PHILADELPHIA, PA 19154

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

12/5/2003
CRUZ-SLEDGE, ANICIA
13 Tremont Street Apt 2
IRVINGTON, NJ 07111

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/3/2015
CUETO, PAOLA (CHHA)
619 THIRTY-EIGHTH STREET
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2017
CUFFE, MAXINE (RN)
33 GREENBROOK DRIVE
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017 8/22/2019
CUI, XIN (CHHA)
119 S. ADELAIDE LANE
HIGHLAND PARK, NJ 08904

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/2008
CULLEN, CHARLES (RN)
PO BOX 861
TRENTON, NJ 08625

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/18/2007
CULLEN, KENNETH
100 MARSHALL AVENUE
TUCKERTON, NJ 08087

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2010
CUNNINGHAM, MICHAEL D. (MD)
PO BOX 505
GLEN SPEY, NY 12737

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
CUPO, DAWN (LPN)
129 ADELPHIA ROAD
FARMINGDALE, NJ 07727

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
CUPOLO, STACY J. (DENTAL HYGIENTIST)
897 INVERNESS CT. APT. A
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
CURETON, WILLIE T.
61 CHELSEA AVENUE
NEWARK, NJ 07106

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/27/2011
CURETON, WILLIE T.
5 UNAMI LANE
SCOTCH PLAINS, NJ 07076

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2009 Permanent
CJC Builders Corp.
220 Mount Pleasant Ave.
Newark, NJ 07104

Curillo Guaman, Owner
197 Broad Street
Newark, NJ 07104

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/8/2016 01/07/2019
CURRY, CHARLES M. (MD)
816 BURNT MILLS ROAD
OLDWICK, NJ 08858

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
CUSTIS, KEVIN (MD)
908 MAIN STREET
ASBURY PARK, NJ 07712

NPI-1811976970
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017 Permanent
CUTLER, JAZMERE (LPN)
131 HUNTLEY AVENUE
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/17/2019
CUVIELLO, CHRISTINA (LPN)
1647 WHITTIER AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/2018
CZYZYK, LISA M. (RN)
12 VILLAGE COURT APT A
TRENTON, NJ 08690

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/13/2013
DACONTI, JOHN (DO)
13 MEDFORD ROAD
MORRIS PLAINS, NJ 07950

NPI-1063460939
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/13/2016
DAFTARY, REKHA B. (MD)
81 B EAST MAIN STREET
MENDHAM, NJ 07943

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/29/2008
DAHAB, YASIR
5 PARK STREET
ROSELAND, NJ 07068

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/12/2001 Permanent
DAHHAN, MOHAMED Z. (MD)
WINDING WAY
WEST PATERSON, NJ 07424

NPI-1417279779
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2008 4/3/2014
DAILY, GALE (CHHA)
14 SUDBERRY LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/19/2001
DALEY, ROBERTA (LPN)
36 HOLLY DRIVE
PARLIN, NJ 08859

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2001
D'ALLEGRO, FRANK (RPH)
32 SUMMIT AVENIE
CEDAR GROVE, NJ 07009

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/5/1990 Permanent
DALTON, ERIN (RN)
14 VICTORIAN WAY
WEST DEPTFORD, NJ 08090

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2013 10/27/2020
DALY, JAMES J. (EMT)
504 EAST FRANKLIN AVENUE
EDGEWATER PARK, NJ 08010

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2013
DALY, LAUREN (MD)
SCI CAMBRIDGE SPRINGS, 451 FULLERTON AVENUE
CAMBRIDGE SPRINGS, PA 16403

NPI-1952492233
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/5/1990
DALY, LAUREN (MD)
SCI CAMBRIDGE SPRINGS, 451 FULLERTON AVENUE
CAMBRIDGE SPRINGS, PA 16403

NPI-1952492233
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
FIVE BROS. SERV. CO., INC
266 BROADWAY
JERSEY CITY, NJ 07306

D'AMBROSIO, MICHAEL
266 BROADWAY
JERSEY CITY, NJ 07306

NPI-

Vendor
Organized Crime Control Act
Suspension

Treasury
Treasury Purchase Bureau

1/9/1996
ROBROS RECYCLING CORP.

,

D'AMBROSIO, MICHAEL
266 BROADWAY
JERSEY CITY, NJ 07306

NPI-

Vendor
Organized Crime Control Act
Suspension

Treasury
Treasury Purchase Bureau

1/9/1996
D'AMICO, DENNIS (RPH)
91 OTTOWA RD SOUTH
MARLBORO, NJ 08817

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/1985 Permanent
DAMMERS, SEAN
255 SANTIAGO AVE
RUTHERFORD, NJ 07070

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/2/2012
Dane DeForest Demolition, Inc.
1508 Beaver Dam Road
Point Pleasant, NJ 08742

Dane DeForest, President
2406 Herbertsville Road
Point Pleasant, NJ 08742

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/16/2016 02/15/2019
DANIEL, ALAN (LCSW)
3 HARRISON PARK LANE
BURLINGTON, NJ 08016

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/17/2000
DANIEL, ALAN L. (LCSW)
415 KEIM BOULEVARD
BURLINGTON, NJ 08016

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/1999
DANIEL, ALAN L. (LCSW)
202 SPRING GARDEN RD
ANCORA, NJ 08037

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2002
DANIEL, THERESA D.
3 HARRISON PARK LANE
BURLINGTON, NJ 08016

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/17/2000
DANIEL-CONOVER, NAHLA (CHHA)
191 RUTLEDGE AVENUE
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/1/2017
DANIELS, BERLYN E. (CHHA)
WHITE HORSE AVENUE
TRENTON, NJ 08610

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/13/2008
DANIELS, CLIFTON
37 HUGHES STREET
MAPLEWOOD, NJ 07040

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2009 7/17/2014
D'ANTIGNAC, CHARLOTTE
3 CHURCHILL DOWNS
W. LONG BRANCH, NJ 07764

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/10/2000
DARA, PARVEZ (MD)
214 COMMONS WAY, BLDNG B
TOMS RIVER, NJ 08755

NPI-1215952775
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/12/2011
DARBY, MARK
1245 ADEE AVENUE, APT 4C
BRONX, NY 10469

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

11/18/2010
DARBY, MARK
SBI305830E, EJSP
RAHWAY, NJ 07065

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/1/2010
D'ASCOLI, BARTHOLOMEW (MD)
PO BOX 1869
MONTAGUE, NJ 07827

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/18/2000 Permanent
DASS, SUMAN K. (MD)
4 BALDWIN AVENUE
JERSEY CITY, NJ 07304

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/4/2000 Permanent
DATCHER, ANTHONY
SCI DALLAS, FOLLIES RD., DRAWER K
DALLAS, PA 18612

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
DATESHIDZE, JANE (RPH)
617 STOKES ROAD, SUITE 4
MEDFORD, NJ 08055

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

6/28/2017
DATILUS, SHELSIE (CHHA)
533 NORWOOD STREET, FL. 1
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/22/2017 Permanent
DAVID, RICHARD
819 EDGEWOOD AVENUE
TRENTON, NJ 08618

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/17/2009 2/17/2016
DAVID, VANESSA (LPN)
204 N. 17TH STREET
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/17/2018
DAVIS, ANTOINETTE
43 VERNON COURT
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/23/2007
DAVIS, CHARLES M. (COUNSELOR)
381 BALA AVENUE
BALA CYNWYD, PA 19004

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/31/2008
DAVIS, CONITA (CHHA)
2 SUTTON DRIVE, APT. O-1
MATAWAN, NJ 07747

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2017
DAVIS, COREY
25 JAMES STREET
LAKEWOOD, NJ 08701

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/12/2006
DAVIS, DEYSHA
12250 ATLANTIC BOULEVARD
JACKSONVILLE, FL 32225

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
DAVIS, ESTELLE (CHHA)
71 HAMILTON STREET
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/31/2018
DAVIS, JAMES DANIEL
145 JUNIPER ST
BROWNS MILLS, NJ 08015

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/4/1988 Permanent
DAVIS, JAMES S.
41 B TROY DRIVE
SPRINGFIELD, NJ 07081

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/1986 9/4/1994
DAVIS, JEFFREY (MD)
5 EAST 63RD STREET
NEW YORK, NY 10065

NPI-1548258189
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/2016
DAVIS, KARIN B. (RN)
141 EAST BENNETT AVE.
WILDWOOD, NJ 08260

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002 4/14/2014
DAVIS, LORETTA (CHHA)
120 CENTRAL PLACE, 202-B
ORANGE, NJ 07050

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/19/2018
DAVIS, MARK S. (DPM)
5 MONTANA DRIVE
COLTS NECK, NJ 07722

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/9/2004
DAVIS, MATHILDA (MD)
230 W JERSEY ST
ELIZABETH, NJ 07202

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/13/1985 Permanent
DAVIS, NICOLE (RN)
544 ACKLEY ROAD
NEWPORT, NJ 08345

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/4/2018
DAVIS, SHANTA (LPN)
114 PLUMTREE LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2019
DAVIS, SHARAE (CHHA)
116 LANFORD STREET
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
DAVIS-HARVEY, DIANA (RN)
10 CAMINO COURT
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/15/2017
DAVIT, SAMUEL (MD)
100 WINSTON DRIVE #B
CLIFSIDE PARK, NJ 07010

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
DAWLEY, ASHALEY (CHHA)
247 MORSE STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
DAWOUD, MONIR A. (MD)
7 COLTSFOOT GLEN
SADDLE RIVER, NJ 07458

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/13/2008
DAWOUD, MONIR A. (MD)
7 COLTSFOOT GLEN
SADDLE RIVER, NJ 07458

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/2007
DAWSON, LATIA (CHHA)
838 4TH AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 11/9/2020
DE LA ROSA ACOSTA, BIENVENIDA (CHHA)
355 OAK STREET, APT. 8
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
DG Construction & Renovations LLC
245 Emanuel St.
Trenton, NJ 08610

Dean Gallo, Owner
245 Emanuel St.
Trenton, NJ 08610

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/5/2016 4/4/2019
DEAN, ARLENE (CHHA)
34 WEST UNION STREET, APT. A
BURLINGTON, NJ 08016

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/3/2019
DEAN, RANDY (MD)
3391 NORTH WEST 99TH AVENUE
CORAL SPRINGS, FL 33065

NPI-1083924807
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
DEANGELO, KRYSTAL (RN)
1314 HANCOCK AVENUE
VANDERGRIFT, PA 15690

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
DEAQUINO, ANTHONY
11 STONE RIDGE LANE
HO-HO-KUS, NJ 07423

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/19/2002
DEBARO, GERRI (RN)
3715 ROYCE COURT
HILLSBOROUGH, NJ 08844

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/12/2019
DEBIASI, RICK (DC)
1 ASHLEY PLACE
TOWACO, NJ 07082

NPI-1861415655
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/30/2016
DECASTRO, ANGELA (LPN)
894 GOSHEN ROAD
CAPE MAY CRT HSE, NJ 08210

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2016
DEEMI, SAMUEL
665 MARTIN LUTHER KING BL
NEWARK, NJ 07102

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/27/2010
DEFEO, DELORES A. (CNA)
RR #6 BOX 280-D
PLEASANTVILLE, NJ 08232

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/26/1996 Permanent
46419517500
ELITE DEMOLITION, LLC
180 Oliver Street
Paterson, NJ 07501

DeFilippi, Stephen

,

NPI-

Construction
Wage & Hour Violation
Debarment

Treasury
Treasury Property Management and Construction

7/14/2016 7/14/2021
DEGILIO, MICHAEL (PSYD)
144 DOGWOOD DRIVE
JIM THORPE, PA 18229

NPI-1356329528
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
DEGUZMAN, DAISY (MD)
111 MULBERRY STREET
NEWARK, NJ 07102

NPI-1699865097
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2014 9/22/2020
DEIXLER, GLENN (CHHA)
262 PRIVATEER ROAD
MANAHAWKIN, NJ 08050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
DEJESUS, YAZMIN (CHHA)
654 OHIO AVENUE
EWING, NJ 08638

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2019
DEKU, FAUSTINA (CHHA)
10 MARSHALL STREET
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
DEL PIANO, ANTHONY (MD)
24 DRINKING BROOK ROAD
MONMOUTH JUNCTION, NJ 08052

NPI-1922032770
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/15/2015
DELA GENTE, ROBERT AKA DELAGENTE, ROBERT (MD)
12 HUNTERS RUN
OAKLAND, NJ 07436

NPI-1891886230
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/12/2019
DELACRUZ, AMELITA (CHHA)
62 LEXINGTON AVENUE
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2018
DELAGENTE, ROBERT AKA DELA GENTE, ROBERT (MD)
12 HUNTERS RUN
OAKLAND, NJ 07436

NPI-1891886230
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/12/2019
DELANCEY, WAYNE K. (PHARM TECH)
1020 HIDEAWAY COURT
VINELAND, NJ 08361

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2011
DELGADO, NICOLE (RN)
81 WALNUT STREET
OAKLAND, NJ 07436

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018
DELGADO, YOKATI (CHHA)
175 BRIGHTON AVENUE
PERTH AMBOY, NJ 08861

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
DELIA, MICHELLE
545 W. HILL ROAD
GLEN GARDNER, NJ 08826

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/7/2010
DELLAPENNA, LINDA (CNA)
52 VAN NESS DRIVE
BRICK, NJ 08723

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/13/2003
DELL'AQUILA, PATRICK
55 BROOKVIEW DRIVE
WOODCLIFF LAKE, NJ 07677

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/25/2014 2/24/2017
DELLAQUILLA, PATRICK
55 BROOKVIEW DR.
WOODCLIFF LAKE, NJ 07677

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/25/2014 2/24/2017
DELOACH, LORRAINE (CHHA)
9 DAVID STREET, APT. 3
SOUTH RIVER, NJ 08882

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
DELUANTO, LILIANA (CHHA)
1160 SUMMIT LANE
MOUNTAINSIDE, NJ 07092

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/2/2018
DELUCA, ANTHONY (MD)
630 PRINCETON AVEMUE
BRICK, NJ 08724

NPI-1043257744
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
DELUCA, ANTHONY (MD)
FCI-FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1043257744
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
DELUCA, WENDY (LPN)
108 GRANDVIEW ROAD
HIGHLAND LAKES, NJ 07422

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/15/2018
DEMARCO, CHARLENE C. (DO)
P O BOX 898801
OKLAHOMA CITY, OK 73189

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2008
DEMARIA JR., WILLIAM R. ( AGENT)
104 WINDSOR COURT
PALM BEACH, FL 33480

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/5/2001
DEMASSI, MICHAEL A. (LCSW)
1917 WATERS EDGE DRIVE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2013
DEMEO, ROBERT (MD)
522 TYSENS LANE, 2ND FL.
STATEN ISLAND, NY 10306

NPI-1043220262
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2015
DEMOSS, KATHLEEN M. (DC)
14 N. MAIN STREET
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2001
DENNIS, MOSES (LPN)
625 GREENWAY AVENUE
DARBY, PA 19023

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/18/2018 Permanent
DENUCCI, NICHOLAS
51 BARN OWL
HACKETTSTOWN, NJ 07840

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/24/2002
DEORIO, ANA G. (RN)
COLUMBIA AVENUE
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2007
DEROSIER-BEAUBRUN, SABRINA (CHHA)
754 SOUTH BROAD STREET
TRENTON, NJ 08611

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2018
DERRICK, NAOMI AKA BASCUS, NAOMI (RN)
6 ENGLISH IVY DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/9/2020
DERRICK, NAOMI AKA BASCUS, NAOMI (RN)
6 ENGLISH IVY DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2016
DESAI, BAKUL (MD)
15 MOUNTAIN RIDGE DRIVE
LIVINGSTON, NJ 07039

NPI-1376654624
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/8/2010 9/10/2019
DESAI, BAKUL (MD)
15 MOUNTAIN RIDGE DRIVE
LIVINGSTON, NJ 07039

NPI-1376654624
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012 9/10/2019
DESAI, NEMISH (DDS)
248 BOONTON TURNPIKE
LINCOLN PARK, NJ 07035

NPI-1598908295
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
DESANTIS, ANTHONY (RPH)
105 FRANKLIN STREET
BELLEVILLE, NJ 07109

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/24/2003
DESIMONE, EUGENE (MD)
FCI FORT DIX, PO BOX 38
JOINT BASE MDL, NJ 08640

NPI-1427098268
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/28/2015
DESIR, MELISSA (CHHA)
20 WILLOW DRIVE, APT. 8
OCEAN, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2017
DESTASIO, VINCENT (MD)
1851 HOOPER AVENUE
TOMS RIVER, NJ 08753

NPI-1043215650
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/13/2016
DESTASIO, VINCENT (MD)
1851 HOOPER AVENUE
TOMS RIVER, NJ 08753

NPI-1043215650
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/12/2016 5/13/2016
DETROLIO, DANIEL (RN)
23 FOXWOOD DRIVE, APT. D
MORRIS PLAINS, NJ 07950

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2018
DEVARIS, HELENA D. (DMD)
35-08 MORLOT AVENUE 1X
FAIR LAWN, NJ 07410

NPI-1679723589
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/21/2013
DEVARSO, ANGELA (RN)
FCI DANBURY, RTE 37
DANBURY, CT 06811

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2012
DEVERA, MONICA T.
118 BEACON STREET
DUMONT, NJ 07628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2002
360 Golf, LLC
300 Mamaroneck Avenue, #733
White Plains, NY 10605

Devin, Lemere, Partner
300 Mamaroneck Avenue, #733
White Plains, NY 10605

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 06/29/2018
DEVLIN, MARYELLEN (RN)
809 DEVON ROAD
RIVERSIDE, NJ 8075

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/4/2018 Permanent
DEZENHALL, MERVIN (RPH)
SUNSET RD AT SUMMIT TURN
WILLINGBORO, NJ 08046

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
DI SPALTRO, FRANKLIN L. (MD)
MELROSE LANE
GREEN VILLAGE, NJ 07935

NPI-1740627082
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2007
DIAZ, CHRISTINA (CHHA)
40 MORRIS STRET, APT. 402
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/22/2019
DIAZ, PEDRO P.
80 SKYTOP ROAD
NEWTON, NJ 07860

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2011
DIAZ-PELLOT, NORMA
500 BERKELY DRIVE
BROWNS MILLS, NJ 08015

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2000 Permanent
DIAZ-PELLOT, NORMA
258 UNIVERSITY AVE
PEMBERTON, NJ 08068

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001 Permanent
DICARLO, ANTHONY G.
35 GALT OCEAN DR
FT LAUDERDALE, FL 33308

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
DICICCO, RICHARD (DC)
1 MYERS AVENUE
BERLIN, NJ 08009

NPI-1073668265
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
DICK, SHONDELL (CHHA)
196 22ND STREET
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018 Permanent
DICKERSON, DENISE M. (RN)
126 HILLCREST AVE, 2A
BLACKWOOD, NJ 08012

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/22/2010
DICOVSKIY, CLAUDIO (MD)
1308 ABBOTT BOULEVARD
FORT LEE, NJ 07024

NPI-1932282845
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2017
DICOVSKIY, CLAUDIO (MD)
1308 ABBOTT BOULEVARD
FORT LEE, NJ 07024

NPI-1932282845
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2015
DICUBELLIS, MICHELE R. (LCSW)
4030 ANDERSON AVE, SE
ALBURQUERQUE, NM 87108

NPI-
Medical
Antitrust/Anti-Kickback Acts
Disqualification

Human Services
Medical Assistance (Medicaid)

6/23/2011 10/22/2014
DIEM, MICHELLE C. (CHHA)
821 NEVILLE STREET
TOMS RIVER, NJ 08753

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/23/2014
DIETERLE, KAREN M. (RN)
51 STURBRIDGE DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
DIETRICH, LISA B.
DOGWOOD TRAIL
RANDOLPH, NJ 07869

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2008
DIETZ, MICHAEL (CHHA)
1602 AQUEDUCT COURT
TOMS RIVER, NJ 08755

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
DIGIORGIO, DAWN K.
13 EAST PINE ST. 13D
WESTVIEW, NJ 08093

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
DIKENGIL, MEHMET #79773-054 (DDS)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1255608279
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/10/2019
DILLARD, LATICIA
4208 NORTH DRIVE
ATLANTIC CITY, NJ 08401

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/24/2013
DILLIGARD, LATASHA (CHHA)
320 W. BRANCH AVENUE, APT. 47C
CAMDEN, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
DILORENZO, PAUL (MD)
22 NORTHWOODS ROAD
OCEAN, NJ 07712

NPI-1699841056
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2017
DILUIGI, KENNETH (RN)
RAVENSWOOD WAY
SEWELL, NJ 08080

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

12/17/2008
DIMEO, ALEXANDER
19355 LASERENA DRIVE
FORT MEYERS, FL 33967

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017
DINKEL, ARTHUR R. (LCSW)
2 FREEMAN LANE
DENVILLE, NJ 07834

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2001 Permanent
DINKEL, ARTHUR R. (LCSW)
2 FREEMAN LANE
DENVILLE, NJ 07834

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/29/2000 Permanent
DIPAOLO, EDMONDO (LPN)
136 DANIELS AVENUE
BROWNS MILLS, NJ 08015

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/9/2020
DIPIERRO, CHARLES G. PRESIDENT
404 SPOTSWOOD GRAVEL HILL
MONROE TWP, NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/25/2011 11/24/2014
DIPIERRO, KEVIN J. V-PRESIDENT
402 SPOTSWOOD GRAVEL HILL
MONROE TWP., NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/25/2011 11/24/2014
DIRENZO, ALFRED M. (DO)
167 GROVE STREET
LODI, NJ 07644

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/21/1995 Permanent
DISCENZA, RONALD (MD)
2578 WOLF HOLLOW ROAD
ANDES, NY 13731

NPI-1528137882
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2017
DITURO, JOSEPH (MD)
376 WOOD RIDGE ROAD
WOODRIDGE, NJ 07075

NPI-1194871459
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/15/2016
DIXIT, DIVY R. (RPH)
3022 EDWARD STEC BLVD
EDISON, NJ 08837

NPI-1619125135
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/2015
DIXON, SHANNON
501 IRVING STREET
CLEMNTON, NJ 08021

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/18/2010 3/18/2013
DJAMBA, MONDJA (CHHA)
17 PHEASANT ROAD
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/6/2017 Permanent
DJAVID, ISMAIL F.
160 EAST 89TH STREE
NEW YORK CITY, NY 10028

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
DLUZNIEWSKI, MICHELE (RN)
137 STEPHAN ROAD
BRICK, NJ 08724

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/7/2019
DOBIECKA, DOROTHY
556 HUMBULT STREET
BROOKLYN, NY 11222

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/4/2014 8/3/2017
DOBRE, FLORAN
526 SHERIDAN AVE.
ROSELLE, NJ 07203

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/2/2013 12/1/2016
DOBROWOLSKI, DONALD A. (DMD)
45 BRICK BLVD. S-108
BRICK, NJ 08723

NPI-1184764664
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/1995 Permanent
DOLINER, PAUL (MD)
401 US HIGHWAY 22
N PLAINFIELD, NJ 07060

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/15/1980 Permanent
DOMINGUES, JOHN
402 MARKET STREET
NEWARK, NJ 07105

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/28/2014 5/27/2017
DOMINIC JR., ANTHONY J. (MD)
216 2ND AVENUE
UPPER MANASQUAN, NJ 08736

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2002
C & E Contracting, Inc.
PO Box 690
Boonton, NJ 07005

DOnald Fleming, President
340 Reservoir Road
Boonton, NJ 07005

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/16/2015 12/15/2018
DONALDSON, DENISE
2650 SPRUCE DRIVE
LAKEHURST, NJ 08733

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/1995 DECEASED
DONALDSON, DENISE
33 3RD AVENUE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/9/2003 DECEASED
Antiveros Construction, Inc.
677 Old Highway 64
Etowah, NC 28729

Donnie Antiveros, President
677 Old Highway 64
Etowah, NC 28729

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/20/2015 10/19/2018
DONOFRIO, CHRISTINE (RN)
207 TULIP LANE
FREEHOLD, NJ 07728

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/3/2017
DONOFRIO, DOUG
1 SPRING LAKE DRIVE
FAR HILLS, NJ 07931

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/4/2012
DOOLEY, CHRISTOPHER J. (PHD)
10 DEER RUN
FREEHOLD, NJ 07728

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/9/2009
DORBOR, BONGO (CHHA)
2341 LIBERTY STREET
HAMILTON, NJ 08629

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
DORIA, LAWRENCE (RPH)
6 BROOK PLAZA
JACKSON, NJ 08527

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/7/1984 Permanent
Cityline Contracting Inc.
556 Humboldt Street
Brooklyn, NY 11222

Dorothy Dobiecka, President
556 Humboldt Street
Brooklyn, NY 11222

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/24/2014 09/23/2017
DORSEY, KIONA (CHHA)
670 W. GROVELAND AVENUE
SOMERS POINT, NJ 08244

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2019
DORVIL, FAUBERT (RN)
651 S. PALM STREET, #201
LITTLE ROCK, AR 72205

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/4/2014
DOSHI, PRIYAKANT S. (MD)
11 WARFIELD STREET
MONTCLAIR, NJ 08625

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/2/1997 DECEASED
DOSSEN, SEBRENA (CHHA)
24 PHILIP E. FRANK WAY
CLIFFWOOD, NJ 07721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018
DOSSOUS, JONAS (CHHA)
1927 BANGS AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/17/2017
DOTOLI, FRANKLIN (MD)
460 FRANKLIN AVE
NUTLEY, NJ 07110

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
DOTRO, ALYCIA AKA ALEXANDRA, ALYCIA (RN)
6 LOWELL ROAD
MANALAPAN, NJ 07726

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2019
D'OTTAVIO, PAOLA (RPH)
WILLOW OAKS DR.
MAYS LANDING, NJ 08330

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/4/2007 Permanent
D'OTTAVIO, PAOLA (RPH)
504 WILLOW OAK DRIVE
MAYS LANDING, NJ 08330

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2011
DOUGHERTY-PRICE, ANITA JO (CHHA)
212 WESTMONT AVENUE
WESTMONT, NJ 08108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/22/2017
DOYLE, GINA PRESIDENT
716 WHITE HORSE PIKE
HAMMONTON, NJ 08037

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/5/2012 4/4/2015
DOYLE, JUDITH M. (RN)
71 WILDFLOWER LANE
MORRISTOWN, NJ 07960

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/20/2004
RONCONE CONSTRUCTION, LLC

,

DOYLE, WILLIAM J.
200 PINE ROAD
HAMMONTON, NJ 08031

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/17/2014 12/16/2017
DRAGERT, ROBERT (MD)
12 E. SEUDDER COURT
PENNINGTON, NJ 08534

NPI-1558522821
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/26/2018 7/21/2020
DRIVAS, GUSTAVE (MD)
FCI LORETTO, PO BOX 1000
LORETTO, PA 15940

NPI-1003867730
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2014
DRIZAN, LOULEA (CHHA)
43B MANLAY MANOR
ELIZABETH, NJ 07202

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
DUAH, GLORIA (CHHA)
68 MYRTLE AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2017
DUARTE, LEONARD (DC)
10 INDEPENDENCE COURT
JACKSON, NJ 08527

NPI-1568681542
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/30/2019
DUBNOFF, MICHELLE (DC)
333 PROVINCIAL DRIVE
MORGANVILLE, NJ 07751

NPI-1225066210
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
DUBOVY, CARL (MD)
11 PIPPINS WAY
MORRISTOWN, NJ 07960

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
DUCHEINE, YVAN (MD)
310 CENTRAL AVENUE
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/1/2017 4/5/2018
DUFF, RICHARD W. (RN)
1260 SUMMERLEA AVENUE
WASHINGTON, PA 15301

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
DUFFIELD, CAMI R. (RN)
119 GRAF AVENUE
LAWRENCEVILLE, NJ 08648

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2000
DUFFY, BARBARA AKA GONZOPH, BARBARA (LPN)
208 WAYNE TERRACE
COLLINGSWOOD, NJ 08108

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
DULL, JOHN W. (DDS)
399 HOOVER AVENUE
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 DECEASED
DUMITRU, DAN (MD)
1657 JFK BOULEVARD FL 1
JERSEY CITY, NJ 07305

NPI-1073639530
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/11/2016
DUQUE, IRMA (CHHA)
314 BROADWAY
ELIZABETH, NJ 07206

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/2007
DURFEE, JANET (RN)
103 WOODLAKE DRIVE
MARLTON, NJ 08053

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2004
DURIVAGE, SHARON (RN/APN)
1655 HUNTERS COURT
YARDLEY, PA 19067

NPI-1407033442
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/4/2018
DURNIEN, EDWARD (CHHA)
215 CREEK ROAD
KEANSBURG, NJ 07734

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/6/2006
DURST, LAWRENCE (RPH)
FCI FORT DIX, PO BOX 38
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2001
DYEVICH, KEVIN
193 LIVINGSTON AVENUE
NEW BRUNSWICK, NJ 08901

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/21/1996 Permanent
DYOUS, KEISHA (LPN)
2 BONNIE COURT
LAWRENCEVILLE, NJ 08648

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/2018 8/22/2019
DZIENISIEWSKI, DONNA J. (RN)
9 IVY LANE
MIDDLETOWN, NJ 07748

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
GLOBAL MEDICAL SYSTEMS

,

DZIUBA, STANISLAW
69 WEST SHORE ROAD
PENNINGTON, NJ 08534

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2015 2/10/2018
DZUIK, CAROL (CHHA)
416 CABLE AVENUE
BEACHWOOD, NJ 08722

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
EASTBURN, NORMAN W. (DC)
424 MATTHEWS LANE
JACKSON, NJ 08527

NPI-1013056670
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/14/2014
EASTMAN, DONALD (OWNER)
292 CHURCH STREET
ABERDEEN, NJ 07747

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/15/2012 9/16/2015
EATOUGH, PHILIP (DO)
5 SYCAMORE LANE
RUMSON, NJ 07748

NPI-1972681674
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2010
EDANIEWSKI, EDWARD R.
113 FRONT STREET
SECAUCUS, NJ 07094

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
Eddy Drywall, LLC
1100 W. 7th St., Apt. A9
Plainfield, NJ 07060

Eddy Rodriguez
1100 W. 7th St., Apt. A9
Plainfield, NJ 07060

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/14/2015 5/13/2016
EDMILAO, CANUNITA
645 NEWARK AVE.
JERSEY CITY, NJ 07305

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/9/2004
EDMONDS, KIANNAH (CHHA)
916 4TH AVENUE
WALL TOWNSHIP, NJ 07719

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/6/2017
Sandora & Spina Contracting Inc.
15 North Branch River Rd.
Branchburg, NJ 08876

Edward Sandora, President
15 North Branch River Rd.
Branchburg, NJ 08876

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/29/2015 06/28/2018
EGANEY, BETH (LPN)
46 REA AVENUE
MIDLAND PARK, NJ 07432

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/28/2019
EGBERT, JENNIFER (CHHA)
PO BOX 1129
FORKED RIVER, NJ 8731

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2018
EGENBERG, IRIS
153 AVENUE B
BAYONNE, NJ 07002

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
EGLOFF, MARY ANN (RN)
1100 KELLY LANE
FRMINGDALE, NJ 07727

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
EIB, KEVIN G.
29 MONMOUTH ROAD
MONROE, NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/3/2014 4/2/2017
EICHHORN, WARREN (DC)
447 NEW ROAD
SOUTHAMPTON, NJ 08088

NPI-1326412297
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2019
EIDMAN, STEVEN (DDS)
73 E. LINCOLN AVE.
ENGLEWOOD, NJ 07631

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2003
EISEMANN, OSHER
345 OAK STREET
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/23/2018
EJIOFOR, UDOKA (RN/APN)
47 KENMORE AVENUE
NEWARK, NJ 07106

NPI-1295096584/1982024790
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/26/2018 10/20/2020
EKSTEROWICZ, DEBORAH (LPN)
283 S. BLACKHORSE PIKE
MOUNT EMPHRAIM, NJ 08059

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
EL SOURY, AHMED #70613-050 (MD)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1497745905
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/4/2018
ELAMIR, MADGY (MD)
14 HIGH MEADOW ROAD N
SADDLE RIVER, NJ 07458

NPI-1710081336
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/18/2015
ELAMIR, MAGDY (MD)
550 SUMMIT AVENUE
JERSEY CITY, NJ 07306

NPI-1710081336
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/5/2010
ELBASHIR, IMAD MAHGOUB
P.O. BOX 7450
TRENTON, NJ 08628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/17/2004
ELBASHIR, IMAD MAHGOUB
160 ALABAMA AVENUE
PATERSON, NJ 07505

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/28/2001
ITPL DIAGNOSTIC LAB, INC./READY CARE CORPORATION
470 CHAMBERLAIN AVENUE
PATERSON, NJ 07522

ELCHAGEA, ISMAIL
470 CHAMBERLAIN AVE
PATERSON, NJ 07522

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/1/2000
ELHAG, ABUBAKER O.
10 HILL STREET APT. 9W
NEWARK, NJ 07102

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/23/2007
ELIA, HARRY R. (DC)
136 BROADWAY
WESTWOOD, NJ 07675

NPI-1104034578
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
ELIA-RAGGIO, LORI (LPN)
4001 BURRYPORT WAY
MOUNT LAUREL, NJ 08054

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/18/2004
Ellen Petric, President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/8/2015 06/07/2018
ELLIEN, WILLIAM (MD)
39 CABBAGE XING
SAVANNAH, GA 31411

NPI-1437196375
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
ELLIOTT, CLAUDIA (CHHA)
345 PARK AVENUE, APT. 4
PATERSON, NJ 07504

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/26/2017
ELLIS, FREDERICK PRESIDENT
2 ISLAND POND ROAD
DERRY, NH 03038

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/27/2012 8/26/2015
ELLIS, KENT R. (MD)
1005 N. WASHINGTON AVE
GREEN BROOK, NJ 08812

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/15/2001 Permanent
ELLISON, RAEFORD (LAC)
8 N. SACRAMENTO AVENUE
VENTNOR, NJ 08406

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/2002
J.C. Maintenance & Repair
1435 71st Street
Brooklyn, NY 11228

Emanuel Cucco, Owner
6725 13th Avenue
Brooklyn, NY 11219

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/15/2016 03/14/2019
EMERSON, BARBARA L. (RN)
45 HAWTHORNE ST.
BROWNS MILLS, NJ 08015

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
REFOCUS GROUP LLC
200 ROUND HILL DRIVE
FREEHOLD, NJ 07728

EMMERICH, MICHELE
200 ROUND HILL DRIVE
FREEHOLD, NJ 07728

NPI-1306342373

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2019
ENEMUO, JOHNNY
215 JACOBY ST., 1ST FLOOR
MAPLEWOOD, NJ 07040

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/1/1999 Permanent
ENEMUO, KENNETH (RPH )
236-242 S. ORANGE AVENUE
NEWARK, NJ 07103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/20/1999 10/26/2017
ENGRISSEI, PATRICIA LEISE (RN)
700 GROVE STREET
HADDONFIELD, NJ 08033

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/18/2005
FAMILY CARE PHARMACY
456 BERGEN AVENUE
JERSEY CITY, NJ 07304

ENOGWE, FELIX (RPH)
51 CLIFTON AVE., C-401
NEWARK, NJ 07104

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/1999 Permanent
ENOGWE, FELIX (RPH)
25 CLIFTON AVENUE
NEWARK, NJ 07104

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/24/2006
ENRICO JR., ANTHONY (DPM)
57 STONEYRIDGE DRIVE
LINCOLN PARK, NJ 07035

NPI-1013095975
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
ENRICO JR., ANTHONY (DPM)
99 SUNCREST AVENUE
NORTH HALEDON, NJ 07508

NPI-1013095975
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/8/2017
ENRICO JR., ANTHONY #71171-050 (DPM)
USP LEWISBURG, PO BOX 1000
LEWISBURG, PA 17837

NPI-1013095975
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2019
Ohana Metal & Iron Works Inc.
60 Miller Rd
Montgomery, NY 12549

Erezy Ohana, Owner
60 Miller Rd
Montgomery, NY 12549

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/6/2014 08/05/2017
All County Pipeline & Site Excavation Inc.
164 Ball Ave
Parsippany, NJ 07054

Eric Charles, President
396 Cherry Ln
Mendham, NJ 07945

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/22/2014 04/21/2017
ERKOBONI, PATRICIA (RN)
1850 W. MCGALLIARD AVENUE
TRENTON, NJ 8610

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/14/2018
ERNST, DAVID J. (DDS)
5 BRUNSWICK WOOD DRIVE
E. BRUNSWICK, NJ 08816

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/31/1995 Permanent
ESCALERA, EMILY (CHHA)
3716 UNION AVENUE, APT. B
PENNSAUKEN, NJ 08109

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/2/2018
ESPADA, MARGARET (CHHA)
310 HAMILTON AVENUE
SEASIDE HEIGHTS, NJ 08751

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
ESPINDOLA, JUAN (MD)
467 CLIFTON AVENUE
CLIFTON, NJ 07011

NPI-1881703726
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/29/2016 4/1/2017
ESPINDOLA, JUAN (MD)
32 FOREST STREET
MONTCLAIR, NJ 07042

NPI-1881703726/1225238074
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/1/2017
ESPOSITO, VINCENT (MD)
5 BUCKINGHAM DRIVE
MADISON, NJ 07940

NPI-1225008253
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
ESQUERRE, RENE (MD)
5 ASHLEY ROAD
WEST ORANGE, NJ 07052

NPI-1033150172
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2018 11/8/2018
ESSER, ARISTIDE HENRI (PSY)
337 N. MAIN STREET, STE 2
NEW CITY, NY 10956

NPI-1447249891
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2013
ESTAMBUL, BERNARDO
605 W.141 STREET, APT 51
NEW YORK, NY 10031

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/31/2008
ESTERMAN, SIDNEY (DPM)
185 CENTRAL AVE, STE. 412
EAST ORANGE, NJ

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/31/2001 Permanent
ETIENNE, FERNANDE (CHHA)
1205 MORRIS STREET #2L
ROSELLE, NJ 07203

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2006
EUSEBIO, EDWIN (CHHA)
220 S. 30TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
EVANS JR., EUGENE (MD)
301 E. LINCOLN AVENUE
ROSELLE PARK, NJ 07204

NPI-1033284930
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/9/2017
EVANS, ROLAND A. (DC)
263 NORTH 3RD AVE.
MANVILLE, NJ 08835

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/3/2003
EVDOKIMOW, DAVID (MD)
96 S. FINLEY AVENUE
BASKING RIDGE, NJ 07920

NPI-1508930678
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/12/2018
Ribles Locksmith & Hardware
613 15th Ave.
Belmar, NJ 07719

Evelyn McDermott, Owner
613 15th Ave.
Belmar, NJ 07719

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/11/2014 07/10/2017
EVRA, JOANEL (CHHA)
1551B ASBURY AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2017
EWING, DIONNA (CHHA)
909 HADDON AVENUE
CAMDEN, NJ 08103

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/2/2018
EZELL, PAUL (MD)
251 SAGEMORE ROAD
HAVERTOWN, PA 19083

NPI-1235130741
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
EZEONYIM, CHARLES I. (RPH)
2153 TYLER STREET
UNION, NJ 07083

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/16/2009 1/6/2012
Old City Remodeling
1406 Lexington Pl
Elizabeth, NJ 07208

Fabricio Franco, Owner
1406 Lexington Place
Elizabeth, NJ 07208

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/10/2013 06/09/2016
FABULIAN, PETER (DO)
26 WEST MAIN STREET
STRASBURG, PA 17579

NPI-1023184835
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2013
FAENZA, MATTHEW (RPH)
64 COVENTRY WAY
RINGWOOD, NJ 07456

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2004
FAERMAN, VLADIMIR (CHHA)
2506 GATES COURT
MORRIS PLAINS, NJ 07950

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/16/2017
FAHE, MIREILLE (RN)
269 MAIN STREET, APT. B
NEW MILFORD, NJ 07646

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017 10/24/2018
FAISON, LAUREN
1804 EAST THAYER STREET
PHILADEPHIA, PA 19134

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
FAKONDO, VICTOR
180 HANSON AVE
PISCATAWAY, NJ 08854

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/18/2011
FALLAH, KEBEH (CHHA)
365 SCHLEY STREET, APT. A8
NEWARK, NJ 07112

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 6/12/2018
FALLUCCA, KARLA JANE (APN/RN)
21 STONEHAM DRIVE
DELRAN, NJ 08075

NPI-1053734095
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/20/2020
FALOWO, YETUNDE
301 MAPLE AVE., APT266
N. PLAINFIELD, NJ 07060

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/6/2006
FARL. MUTALIB (CHHA)
61 NORTH ARLINGTON AVENUE
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/3/2018
FARRIS, JOEL (CHHA)
212 UNION AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2001
FARRO, ANDREW
87 CASTLE RIDGE DRIVE
EAST HANOVER, NJ 07936

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/12/2008
FARRO, FRANCESCO
21 LAKEVIEW COURT
ROCKAWAY, NJ 07866

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/4/2015 2/3/2018
FASANO, JUDITH (RN)
1770 YORKTOWNE BOULEVARD
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
FASWALA, MUNIR H. (MD)
506 LAGOON BLVD.
BRIGANTINE, NJ 08203

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/15/2008
FASWALA, MUNIR H. (MD)
506 LAGOON BLVD.
BRIGANTINE, NJ 08203

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/26/2005
FATATO, VIRGINIA A. (DC)
8 N. WHITEHORSE PIKE
HAMMONTON, NJ 08009

NPI-1437432960
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/5/2003
FAULX, LORI (RN)
4444 N. 7TH AVENUE, APT. 417
PHOENIX, AZ 85013

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
FAUSTINO, ALAN (MD)
110 WEST CHURCH STREET
ABSECON, NJ 08201

NPI-1669482568
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/29/2016 3/8/2019
FAUSTINO, ALAN (MD)
28 W. GILMAR CIRCLE
MARGATE CITY, NJ 08402

NPI-1669482568
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/8/2019 Permanent
FAUSTINO, ALAN (MD)
830 PLYMOUTH PLACE, UNIT 2
OCEAN CITY, NJ 08226

NPI-1669482568
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
FEE, CATHERINE ANN (RPH)
7353 CLUBHOUSE CIRCLE
EGG HARBOR CITY, NJ 08215

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
FEINBERG, IRA
411 CHELSEA STREET
PARAMUS, NJ 07652

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
FEINMAN, BRIAN (DPM)
418 WALNUT STREET
NEWARK, NJ 07105

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006 Permanent
FEIT, FREDRIC (MD)
2 TWIN LAKES DRIVE
MANALAPAN, NJ 07726

NPI-1093835308
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/13/2009
FELDMAN, BRUCE J.
807 NORTHWINDS DRIVE
BRYN MAWR, PA 19010

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/18/2004
FELDMON, DORON (MD)
FCI MCKEAN, PO 8000
BRADFORD, PA 16702

NPI-1194704627
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
FELDNER, EDWARD S. (MD)
50 E MAIN STREET
LITTLE FALLS, NJ 07424

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/16/1999 DECEASED
Felipe Villagomez
160 Lincoln Street
Bridgeton, NJ 08302

Felipe Villagomez, Owner
160 Lincoln St
Bridgeton, NJ 08302

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/9/2016 03/08/2019
FELIX, JESSICA (CHHA)
40 PASSAIC STREET, APT. 4D
HACKENSACK, NJ 07601

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/14/2015
FELLUS, JONATHAN L. (MD)
57 WOODLAND AVENUE
GLEN RIDGE, NJ 07028

NPI-1053309195
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015 5/21/2020
FELSENBERG, SANFORD
517 SO ORANGE AVENUE
NEWARK, NJ 07103

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
FERMIN, ESPERANZA (CHHA)
229 MADISON AVENUE, APT. #1
PATERSON, NJ 07524

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
FERNANDES, HUGO
90 WILLOW STREET
CARTERET, NJ 07008

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/28/2015 1/27/2018
FERNANDEZ, LUIS (DPM)
293 MONROE STREET
PASSAIC, NJ 07055

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/26/1997 Permanent
MF Speed Construction, LLC.
65-67 7th Ave. 1st Floor
Newark, NJ 07104

Fernando Lopes, President
65-67 7th Ave 1st Floor
Newark, NJ 07104

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/17/2013 10/16/2016
FERRANDINO, LUIGI (MD)
8 EAST RAMAPO AVENUE
MAHWAH, NJ 07430

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2007 Permanent
FERRARI, FRANCIS M. (DPM)
482 KEARNEY AVENUE
KEARNY, NJ 07032

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/16/1995 Permanent
FERREIRA, NUNO PRESIDENT
295 BALTURSOL WAY
SPRINGFIELD, NJ 07081

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/8/2012 5/7/2015
FERRINGO, MICHAEL J.
616 GLEN COURT
TURNERSVILLE, NJ 08012

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2012
FERSTANDIG, RUSSELL A. (MD)
179 MAPLE AVE.
RIDGEWOOD, NJ 07450

NPI-1780779702
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/7/1987 1/1/2013
FIELDS, CARENE (CHHA)
190 HAMILTON AVENUE, APT. #8
PATERSON, NJ 07501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
FIGUEROA, DESIREE (CHHA)
11 COLLETON STREET
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
FIGUEROA, JORGE (MD)
493 21ST AVENUE
PATERSON, NJ 07513

NPI-1770542151
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/23/2018
FIGUEROA, JORGE (MD)
USP LEWISBURG, PO BOX 1000
LEWISBURG, PA 17837

NPI-1770542151
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
FILIPONE JR., DENNIS R. (MD)
147 STANTON ROAD
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/21/1998 Permanent
FINDER, RICHARD (DC)
810 ABBOTT BLVD.
FORT LEE, NJ 07024

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/1/2004
FINE, EDWARD (MD)
271 MOORE LANE
HADDONFIELD, NJ 08033

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/28/1983 Permanent
FINESMITH, ROSS (MD)
PARKVIEW AVENUE
BASKING RIDGE, NJ 07920

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
FINK, DAVID (PSYCH)
139 HIGHLAND AVENUE
METUCHEN, NJ 08840

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2003
FINKEL, MARINA
EDNA MAHAN CORRECTIIONAL
CLINTON, NJ 08809

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2014
FINKEL, MARINA
75 STONEGATE DRIVE
STATEN ISLAND, NY 10304

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2013
FISCHBERG, JUAN C. (MD)
354 RUSSELL AVENUE
EDGEWATER, NJ 07020

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2008
FISCHGRUND, JOEL (MD)
56 CORNELL DRIVE
LIVINGSTON, NJ 07039

NPI-1427097534
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/30/2014
FISCHGRUND, JOEL (MD)
56 CORNELL DRIVE
LIVINGSTON, NJ 07039

NPI-1427097534
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2017
FISCHMAN, HAROLD (MD)
56 BOWDOIN ST
MAPLEWOOD, NJ 07040

NPI-
Medical
Industry Law Violation
Disqualification

Law and Public Safety
Consumer Affairs Board of Medical Examiners

6/1/1993 Permanent
FISH, MICHAEL (DMD)
1500 PINE PARK AVENUE
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/20/2007 7/17/2013
FISHER, CALLETTA (PHARM TECH)
115 SENACA BOULEVARD
BARNEGAT, NJ 08005

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
FISHER, DARRYL
55 SHELBOURNE STREET
BURLINGTON, NJ 08016

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2006
FLEISCHER, MARK H. (MD)
FCI-OTISVILLE, PO BOX 600
OTISVILLE, NY 10963

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2005
FLEISCHMAN, EDWARD (DO)
3804 CHURCH ROAD
MOUNT HOLLY, NJ 08054

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/25/1998
FLEMING, KEVIN M. (MD)
710 STATION AVENUE 2 FLR
HADDON HEIGHTS, NJ 08035

NPI-1508816075
Medical
Contingent Fees
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2010
FLEURANTIN, MARIE (RN)
14 OAK TREE COURT
WESTAMPTON, NJ 08060

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/24/2018
FLEURANTIN, RUBEN J.
SCOTLAND ROAD
SO. ORANGE, NJ 07079

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2008
FLEURY, DIANE (RN)
552 PENNY STREET
FRANKLINVILLE, NJ 08322

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
FLORES, CARMEN (CHHA)
95 PROSPECT STREET, APT. #1
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
FLORES, MARIE MIRAVITE (RN)
258 DEEP BROOK COURT
PISCATAWAY, NJ 08854

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/20/2004
FLORES, MELBA (CHHA)
106 MAPLE AVENUE
BOONTON, NJ 07005

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
B & B Atlantic LLC
526 Sheridan Ave.
Roselle, NJ 07203

Florian Dobre, Partner
526 Sheridan Ave.
Roselle, NJ 07203

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/27/2013 08/26/2016
FLOUNDERS, JOSEPH P. (LPN)
106 W. MIAMI AVE.
VILLAS, NJ 08251

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2005
FLOWERS JR., HERMAN J. (CHHA)
143 URSINUS COURT
PEMBERTON, NJ 08075

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/10/1997 Permanent
FLOWERS, FELICIA (CHHA)
321 NEPTUNE BOULEVARD
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
FLOWERS, HERMAN T.
143 URSINUS COURT
PEMBERTON, NJ 08075

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/16/1999
FLOYD, JAMES A. (PHD)
1733 BLAKE BOTTOM ROAD NW
HUNTSVILLE, AL 35806

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2010
FOGLER, SEAN (MD)
1900 HAMILTON STREET
PHILADELPHIA, PA 19130

NPI-1548322068
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
FOGLER, SEAN (MD)
201 N. 8TH STREET, UNIT 911
PHILADELPHIA, PA 17105

NPI-1548322068
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2019
FOLK, THOMASA A.
463 IRVINGTON AVENUE
ELIZABETH, NJ 07201

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/19/2006
FOLKERTS, ANNAMARIA M. (MD)
32 OAK PLACE
HAWTHORNE, NJ 07506

NPI-
Medical
Industry Law Violation
Disqualification

Law and Public Safety
Medical Assistance (Medicaid)

12/8/1993 Permanent
FONTANELLA, DANIEL (DC)
27 MOUNTAINWOOD COURT
TOTOWA, NJ 07512

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2003
FONTANEZ, MODESTO (MD)
1838 2ND AVENUE
NEW YORK, NY 10128

NPI-1851395826
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/7/2011
FORBES, AASE (RN)
882 DEWEY STREET
UNION, NJ 07083

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2009
FORD, MARYKATE (RN)
103 SWEETWATER DRIVE
CINNAMINSON, NJ 08077

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/30/2018
FORD, TAMIKA (CHHA)
600 ELM STREET
CAMDEN, NJ 08102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
FORDE, SHIVONNE
57 CHESTNUT STREET C4
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/8/2010 3/8/2015
FORMAN, STEVEN (DPM)
15 CANTERBURY PLACE
SICKLERVILLE, NJ 08081

NPI-1700850096
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/18/2017
FORNEY, DONALD
354 CRESCENT STREET
HARRISBURG, PA 17104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
FORSHAY, LAUREN (RN)
2201 RIVER ROAD
PT. PLEASANT BORO, NJ 08742

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016 6/26/2017
FORTE, GARY
44 SUMMIT AVENUE
BERLIN, NJ 08009

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001
FORTI, PAUL J. (PSYCH)
6 SILVER SPRING COURT
EAST HANOVER, NJ 07936

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001 Permanent
FORTUNATO, FRANKLIN (MD)
FMC-DEVENS, PO BOX 879
AYERS, MA 01432

NPI-1548278930
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
FORTUNATO, FRANKLIN D. (MD)
127 PINE STREET
MONTCLAIR, NJ 07042

NPI-1548278930
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/29/2015
FOSTER, DEBRA (CHHA)
714 ZLOTKIN CIRLCE, APT. 6
FREEHOLD, NJ 07728

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2017
FOWLER, BERNARD J. (MD)
1341 MIDDLE GULF DRIVE 12D
SANIBEL, FL 33957

NPI-1326105032
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015
FOWLER, BERNARD J. (MD)
15 GRIST MILL RUN
MAHWAH, NJ 07430

NPI-1326105032
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2014
FOX, SUSAN (DMD)
2300 WALNUT STREET
PHILADEPHIA, PA 19103

NPI-1952661472
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
FRAENKEL, DAVID M. (DDS)
BERGEN MALL DENTAL OFFICE
PARAMUS, NJ 07652

NPI-1790774271
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

11/4/1991 4/5/2018
FRAJDENBERG, THERESA
110 S. HARDING HIGHWAY
LANDISVILLE, NJ 08326

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/2/2016 2/1/2019
FRANCILLON, CARLINE (LPN)
98 ASHLAND ACENUE, 2ND FLOOR
WEST ORANGE, NJ 07052

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/13/2017
FRANCO, DAISY (CHHA)
URB JARDIN DE S. ANNA
COAMO, NJ 00769

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
FRANCOIS, EMMANUEL (MD)
187 HOBART GAP ROAD
LIVINGSTON, NJ 07039

NPI-1457383382
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/10/2016 7/19/2019
FRANCOIS, ESTHER (CHHA)
514 LIDGERWOOD AVENUE
ELIZABETH, NJ 07202

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/2018
Heritage Hills Estates
100 Liberty Dr
Millville, NJ 08332

Frank Carpine, Owner
3730 S. Delsea Dr
Vineland, NJ 08360

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/4/2016 01/03/2019
East Coast Touch Enterprises, LLC
152 Jackson St
Newark , NJ 07105

Frank Loutner, Vice President
152 Jefferson St
Newark , NJ 07105

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/12/2014 8/11/2017
Frank Montgomery Builder
42 Bryant Rd.
Waretown, NJ 08758

Frank Montgomery, Owner
42 Bryant Rd
Waretown, NJ 08758

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/11/2014 07/10/2017
FRANK, OLEG (MD)
40 FERRY STREET
NEWARK, NJ 07105

NPI-1457469090
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/9/2016 2/7/2020
FRARE, ROBERT (DMD)
15 PROMENADE PLACE
VOORHEES, NJ 08043

NPI-1740477553
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2014 Permanent
FRASCA, CLIFFORD C.
637 WESTON DRIVE
TOMS RIVER, NJ 08755

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/8/1999 Permanent
FRASER, KEITH (MD)
6 WEDGEWOOD DRIVE, UNIT7
VERONA, NJ 07044

NPI-1881621266
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/10/2011 12/4/2014
FRASER, SHAWN E.
P.O. BOX 7000
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2005
FREDERICK, KIMBERLY M. (RN)
78 BOUNDARY AVENUE
HANOVER, PA 17331

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/12/2008
FREE, JOSEPH
149 GARFIELD AVENUE
STATEN ISLAND, NY 10305

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/6/2013 3/5/2016
FREE, KEVIN R. (MD)
14 PATTEN TERRACE
CEDAR GROVE, NJ 07009

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/1998 Permanent
FREILER, JOHN (DMD)
2307 WARRENS WAY
WANAQUE, NJ 07465

NPI-1295815710
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2018
FREMPONG, EBENEZER (CHHA)
30 POST STREET, APT. 6M
YONKERS, NY 10705

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/2/2018
FRENCH, EUGENE (MD)
241 SUMMIT AVENUE
HACKENSACK, NJ 07601

NPI-1215927843
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/18/2016
FRICK, JAEMS
1626 ABBOT AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/5/2004
FRIDMAN, LEV (CHHA)
6 SALT MEADOW ROAD
EAST BRUNSWICK, NJ 08816

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/2/2017
FRIED, MARTIN (MD)
5 SHINNECOCK HILLS DRIVE
ASBURY PARK, NJ 07712

NPI-1407087802
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/17/2018
FRIED, MARTIN (MD)
5 SHINNECOCK HILLS DRIVE
ASBURY PARK, NJ 07712

NPI-1407087802
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/21/2019
FRIEDMAN, AMIR (MD)
390 N. BROADWAY, STE 1000
PENNSVILLE, NJ 08070

NPI-1417907361
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/1/2014 8/11/2016
FRIEDMAN, LAWRENCE A. OWNER
1688-90 54TH STREET
BROOKLYN, NY 11024

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/16/2002
FRIEDMAN, SHERRY (RN)
12 HOPI TRAIL
OAK RIDGE, NJ 07348

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
FRIEDMAN, STRASSMAD BARB
5 ROANOKE AVENUE
ROCKAWAY, NJ 07866

NPI-

Criminal Offense
Disqualification

Treasury
Treasury Property Management and Construction

12/1/1998 Permanent
FRIEND, CHARLES (LPN)
2336 CORBETT RD
PENNSAUKEN, NJ 08109

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
FRIMPONG, JOSEPH (CHHA)
357-363 LINCOLN AVENUE, APT. 3D
ORANGE, NJ 07050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
FRIMPONG, KOFI (LPN/RN)
ESSEX ROAD
MAPLEWOOD, NJ 07040

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/20/2007
FRISCH, FREDERICK (MD)
7 SOUTH DUDLEY AVE.
VENTOR, NJ 08406

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/1994 DECEASED
FRITTS, LARRY F. (RN)
5 AUTUMN RIDGE LANE
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
FRITZ, GINA (LPN)
52718-2 PIMA COURT
KILEEN, TX 76543

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/14/2018
FROHWIRTH, DANIEL H. (MD)
MEADOW RD P O BOX 274
WHITEHOUSE, NJ 08888

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/1992 Permanent
FROMER, CARL H. (MD)
1000 CLOVER ROAD, APT 7R
STATEN ISLAND, NY 10314

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2000 Permanent
FROMM, JOSEPH MICHAEL
28301 ATLANTIC AVE.#110 S
ATLANTIC CITY, NJ 08401

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/17/1991 Permanent
FROSCH, LISA AKA PLOTTS, LISA (RN)
111 BEECHWOOD AVENUE
OAKLYN, NJ 08107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
FRYE, ROBIN (CHHA)
1224 WASHINGTON AVENUE
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/13/2018 Permanent
FRYER, CYNTHIA (LPN)
PO BOX 121
MERRY HILL, NC 27957

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2017
FURLONG, KELLY AKA COPPOLA, KELLY (PHARM TECH)
52 CORNELL DRIVE
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/2016
GABER, ROBERT A. (DDS)
100 VAIL ROAD
PARSIPPANY, NJ 07054

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/1988 Permanent
Galindo Const. LLC
1025 23rd St
Paterson, NJ 07513

Gabino Galindo, Owner
1025 23rd St
Paterson, NJ 07513

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/7/2015 08/06/2018
GABRIEL, NWALA (RPH)
34 SCHOOL STREET
PISCATAWAY, NJ 08854

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2010
GADHOK, RAJINDER S.
120 CIRCEL AVE., BOX 121
BERKELY HGHTS, NJ 07922

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/12/1997 Permanent
GAFFNEY, JOHN (DO)
9501 VENTNOR AVENUE
MARGATE CITY, NJ 08402

NPI-1710985387
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/24/2017
GAINER, JAHNIA (PHARM TECH)
11 14TH AVENUE
NEWARK, NJ 07103

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/26/2016
GAINES, TONI
4650 COLES MILL ROAD R-3
WILLIAMSTOWN, NJ 08094

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/4/2012 8/3/2014
GAITHER, HERBERT (MD)
1453 HILLCREST COURT, APT. 407
CAMP HILL, PA 17011

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
GALCIK, DIANE (LPN)
34 MAHAN STREET
TENAFLY, NJ 07670

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2001
GALIN, MILES A. (MD)
EAST END AVENUE
NEW YORK, NY 10128

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/19/2008
GALINSKY, KIMBERLY (RPH)
220 VAN FLEET AVENUE
SOUTH PLAINFIELD, NJ 07080

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2017
GALINSKY, RONALD C. (PSYCH)
34 DUNHILL DRIVE
VOORHEES, NJ 08043

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
GALL, WILLIAM J. (DO)
22 STONEGATE COURT
BLACKWOOD, NJ 08012

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2009 Permanent
GALLAGHER JR., WALTER B. (RN)
132 TULIP LANE
SUMMIT, NJ 07901

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2005
GALLAGHER, BRENDA JO (RN/LPN)
14B WISHING WELL ROAD
HAMBURG, NJ 07419

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/19/2001
GALLAGHER, JOANNE M. (DC)
108 BENJAMIN AVENUE
CONYNGHAM, PA 18219

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2005
GALLAGHER, PATRICIA A. (RN)
111 QUAKER ROAD
MICKLETON, NJ 08056

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2014
GALLAGHER, STEPHEN OWNER
221 COOLIDGE ST, STE. 11
LINDEN, NJ 07036

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/30/2012 7/29/2015
GALLE, JAMES (RPH)
105 ELM AVENUE
HACKENSACK, NJ 07644

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2003
GALLETTA, ERNEST
FCI FAIRTON P.O. BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2009
GALLETTA, GEORGE W.
3001 E. CHESTNUT AVE A1
VINELAND, NJ 08361

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/19/2009
GAMAO, EDDIE (MD)
375 NORTH DRIVE, J9
NORTH PLAINFIELD, NJ 07060

NPI-1639479397/1770500423
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/14/2018
GAMAO, EDDIE (MD)
375 NORTH DRIVE, J9
NORTH PLAINFIELD, NJ 07060

NPI-1639479397/1770500423
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/31/2018 Permanent
GAMUZZA, VINCENT #70500-050 (OPTOMETRIST)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1063851285
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2018
GANDHI, HIREN
120 ROLLING BROOK DRIVE
EDISON, NJ 08820

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2005
GANETSKY, SVETLANA (PT)
197 SOUTH EDWARDS DRIVE
SOUTHAMPTON, PA 18966

NPI-1407180037
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
GANTI, SHASHI (MD)
2035 HAMBURG PIKE
WAYNE, NJ 07410

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/1997 3/3/2020
GARCEN, GINA AKA CIALLELLA, GINA (DC)
57 GREEN STREET
WOODBRIDGE, NJ 07095

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2000 Permanent
GARCIA, DIANE (LCSW)
6612 TERRA DOLCE AVE NW
ALBUQUERQUE, NM 87114

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/18/2012
GARCIA, SHEILA (CHHA)
1003 W. CHAPLAIN ROAD
MANVILLE, NJ 08835

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
GARDINER, MICHAEL A. (DC)
2066 MILBURN AVENUE
MAPLEWOOD, NJ 07040

NPI-1346524907
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/3/2003
GARIPALLI, LAXMIPATHI (MD)
11 COLTS GAIT LANE
COLTS NECK, NJ 07722

NPI-1851325500
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/21/2008
GARIPALLI, LAXMIPATHI (MD)
11 COLTS GAIT LANE
COLTS NECK, NJ 07722

NPI-1851325500
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012
GARRETSON, MATTHEW (PHARM TECH)
119 GLEN AVENUE
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/2016
GARRITANO, RALPH E. (MD)
281 GROVE ST
ORADELL, NJ 07649

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
GAULT, TYMIER (CHHA)
180 HAYNES AVENUE
BRIDGETON, NJ 08302

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/22/2017
GAYLE, DELORES (MD)
249 GREGORY AVENUE
WEST ORANGE, NJ 07052

NPI-1508886664
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015 6/5/2017
GAYLE, DELORES (MD)
249 GREGORY AVENUE
WEST ORANGE, NJ 07052

NPI-1508886664
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017 Permanent
GAYLE, LURINE (CHHA)
2144 ALDRIN ROAD, #5A
OCEAN, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
GECYS, GINTARE T. (DO)
1504 BLACKWOOD CLEMENTON
BLACKWOOD, NJ 08012

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/22/2015 5/21/2020
GEFFEN, STEVEN
50 SKYLARK COURT
MARLBORO, NJ 07746

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/15/2000 Permanent
GENNINGER, LEWIS E. (MD)
95 SOUTH MAIN ST
PHILLIPSBURG, NJ 08865

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

1/10/1988 DECEASED
GENSHEIMER, MAUREEN (LPN)
1409 EDGEMERE ROAD
WALL, NJ 07719

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
Midwest Construction, Inc.
114 Brace Rd
Cherry Hill, NJ 08034

George Antonas, President
114 Brace Road
Cherry Hill, nJ 08034

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/24/2014 07/23/2017
Low Bid, Inc. SUSPENDED PENDING DEBARMENT
125 East Broadway Suite 507
Long Beach, NY 11581

George McNulty, President
125 East Broadway Suite 507
Long Beach, NY 11561

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/0/1900 SUSPENDED
GEORGE, JOBY (RPH)
395 MYRTLE STREET
CLIFFWOOD, NJ 07721

NPI-1255481917
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2011
GERARD, ROBERT
144 DORSETT DRIVE
WALL, NJ 08719

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
1020

4/12/2017 4/12/2027
GERARDO, LETRICIA M. (MD)
317 MT. PROSPECT AVE.
NEWARK, NJ 07104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/30/1997 Permanent
GERMAN, MARIA (CHHA)
195 BROADWAY
PATERSON, NJ 07505

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/24/2002
GETSON, LEE
7 HAMILTON COURT
SOUTHAMPTON, NJ 08088

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
GIACALONE-HEWSON, MARIA (DC)
FCI COLEMAN MEDIUM, PO BOX 1032
COLEMAN, FL 33521

NPI-1487782504
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
GIALANELLA, CRAIG (MD)
4 OXFORD ROAD
NORTH CALDWELL, NJ 07006

NPI-1467596502
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2017
GIAMPORCARO, STEVEN (MD)
15 GLEN AIRE DRIVE
EGG HARBOR TOWNSHIP, NJ 08234

NPI-1255356994
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/22/2019 Permanent
INTERCONTINENTAL MEDICAL
185 BROADWAY #14
PATERSON, NJ 07505

GIANETTI JR., JOSEPH P. (DC)
LINDEMAN AVENUE
CLOSTER, NJ 07624

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/18/2008
GIANNOTTO, ANTHONY (MD)
31 PALM STREET
NEWARK, NJ 07106

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

11/24/1988 Permanent
GIARRETTA, MARY SUEANNE (RPH)
9 KINGWOOD AVE
FRENCHTOWN, NJ 08825

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/15/2001 Permanent
GIBBONS, SHANIKA (CHHA)
11 LINDEN AVENUE
EDISON, NJ 08817

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
GIBBONS, SHAWN S.
40 DOVER STREET
NEWARK, NJ 07106

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/24/2007
GIBBONS, WAYNE L. (MD)
2 EAST RIVER DRIVE
WILLINGBORO, NJ 08046

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/12/2001 Permanent
GIBBS, ARLENE (CHHA)
18 BELLEVILLE CT APT C
BELLEVILLE, NJ 07109

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2007
GIBBS, ARLENE (CHHA)
35 CIVIC SQUARE, #23
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/28/2006
GIBBS, MARY ELLEN (CHHA)
157 ANDREW STREET
HAMILTON, NJ 08610

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/14/2002
GIBNEY, EDWARD D.
10 CEDAR LAKE
DENVILLE, NJ 07834

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
GIBSON, MARY E.
376 MADISON AVENUE
RAHWAY, NJ 07065

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
GIFFINS-MATLACK, DEANNE (LPN)
46 BURT STREET
BRIDGETON, NJ 08302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
GILL, ALYSON R. (RN)
115 BRADLEY COURT
LAUREL SPRINGS, NJ 08021

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
GILL, JEFFREY J. (DPM)
1168 BEACON AVENUE
MANAHAWKIN, NJ 08050

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/13/1999 Permanent
GILL, YURI (CHHA)
13 PINE GLEN DRIVE
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2017
GILLARD, MARY (RN)
321 SUNSET AVE., APT.2H
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
GILLER, LEONID
4 WOODFERN STREET
EDISON, NJ 08820

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/27/1999 Permanent
GILLIARD, MICHELLE (CHHA)
2929 HURLEY POND ROAD
WALL, NJ 07719

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/20/2017
GILLISS, ADAM (DO)
27 EAST CHESTNUT AVENUE
MERCHANTVILLE, NJ 08109

NPI-1982741328
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
GILMAN, DANIEL
FCI - FAIRTON, PO BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
GILMAN, DENISE (DO)
108 WOODCREST DRIVE
CORAOPOLIS, PA 15108

NPI-1689986960
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015 9/19/2016
GILMORE, BRUCE STEWART (MD)
FRANKLIN DRIVE
ARDMORE, OK 73401

NPI-1306985882
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/18/2008

JEROME DRUGS
7320 VENTOR AVENUE
VENTOR, NJ 08406

GILTMAN, JEROME (RPH)
7320 VENTOR AVENUE
VENTOR, NJ 08406

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/2007 Permanent
Cobra Communications & Installations, LLC
26 Spencer Place
Garfield, NJ 07026

Giovanny Bustos, Owner
265 Wilson Avenue
Kearny, NJ 07032

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/11/2014 12/10/2017
GIRARDY, MATTHEW (DDS)
1285 BRADFORD RUN
SPRING LAKE, NJ 7762

NPI-1831278118
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2019
GITKIN, SAMUEL
1288 15TH STREET
FORT LEE, NJ 07024

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/2002
GLASER, VICTORIA M. (RN)
1612 THIRD STREET
RENSSELAER, NY 12144

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
GLASS, JOEL (MD)
2027 SPRING GARDEN STREET
PHILADEPHIA, PA 19130

NPI-1861537219
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017 Permanent
GLASS, JOEL (MD)
2027 SPRING GARDEN STREET
PHILADEPHIA, PA 19130

NPI-1861537219
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/27/2017 Permanent
GLASS, MICHAEL (MD)
1345 SLATERVILLE ROAD
ITHACA, NY 14850

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/18/2007
GLEASON, WALTER
252 LILLBRIDGE APTS.
CLEMENTON, NJ

NPI-
Vendor
Criminal Offense
Vendor

Treasury
Treasury Purchase Bureau

8/27/2001
GODBOLT, KIMISHA (CHHA)
190 HAMILTON AVENUE
PATERSON, NJ 07501

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/24/2017
GODWIN, LASTAISA (PHARM TECH)
6 HILLSIDE TERRACE
SUSSEX, NJ 07461

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/1/2018
GOLDBERG, ARTHUR
PO BOX 239
AVERNE, NY 11692

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000
GOLDBERG, CHARLES S. (MD)
FCI-OTISVILLE, PO BOX 1000
OTISVILLE, NY 10963

NPI-1164443958
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/22/2016
GOLDBERG, JESSE G. AKA BLACKFORD, JOSHUA
316 SEATON AVENUE
ROSELLE PARK, NJ 07204

NPI-
Vendor
Industry Law Violation
Suspension

Treasury
Treasury Purchase Bureau

10/12/2004
GOLDBERG, RICHARD (MD)
FEDERAL BUREAU PRISONS-RRM #66231-050, 100 29TH STREET
BROOKLYN, NY 11232

NPI-1629136320
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/9/2017
GOLDBERG, RICHARD (MD)
95 DAVIS HILL ROAD
WESTON, CT 06883

NPI-1629136320
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/1/2015
GOLDIS, MICHAEL (MD)
36 STOKES ROAD
MOUNT LAUREL, NJ 08054

NPI-1982603247
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/30/2020
GOLDSTEIN, JACK (DO)
695A MAIN STREET
LUMBERTON, NJ 08048

NPI-1154355055
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/28/2014 DECEASED
GOLDSTEIN, JACK (DO)
695A MAIN STREET
LUMBERTON, NJ 08048

NPI-1154355055
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015 DECEASED
GOLDSTEIN, JEFFREY (DO)
90 BARNARD ROAD
NEW ROCHELLE, NY 10801

NPI-1831158088
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/14/2021 Permanent
GOLDTHWAITE, JENNIFER (LPN)
507 KENBURY ROAD
BRANCHBURG, NJ 08876

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/15/2018
GOLEJ, IVY (RN)
631 MARION ROAD
NEPTUNE, NJ 07753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/9/2016
GOLEV, DIMO
7 ROSELAND AVENUE
TOTOWA, NJ 07512

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/10/2014 6/9/2017
GOLIN, MARK W. (MD)
172 FRANKLIN AVE., SUITE4
RIDGEWOOD, NJ 07450

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2003
GOMEZ, ALFREDO (CHHA)
148 NORTH 10TH STREET, 2ND FLOOR
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/26/2018
GOMOLINSKI, NANCY ( LCSW)
23 FORSHEE CIRCLE
MONTVALE, NJ 07645

NPI-1700986890
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/7/2014
GONSHERY, DENISE C. (RPH)
900 MCELWEE ROAD
MOORESTOWN, NJ 08057

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2005
GONZALEZ, ARELIS (CHHA)
28 MADOLE PLACE
PENNS GROVE, NJ 08069

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
GONZALEZ, EFRAIN
256 GROVE STREET
NORTH PLAINFIEL, NJ 07060

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/6/2012 3/5/2015
GONZALEZ, FELICIA E. (DO)
1203 GREEN VIEW WAY
TOMS RIVER, NJ 08753

NPI-1598850935
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/19/2011 6/17/2013
GONZALEZ, JORDAN (RPH)
FCI FAIRTON #66214-050, PO BOX 420
FAIRTON, NJ 08320

NPI-1992073167
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/9/2017
GONZALEZ, LEAH (CHHA)
5 TWIN RIVERS DRIVE
EAST WINDSOR, NJ 08520

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/16/2017 5/6/2021
GONZOPH, BARBARA AKA DUFFY, BARBARA (LPN)
208 WAYNE TERRACE
COLLINGSWOOD, NJ 08108

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
GOOBERMAN, LANCE (MD)
1 SOUTH CENTRE STREET
MERCHANTVILLE, NJ 08109

NPI-1194998682
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/24/2004 7/23/2012
GOODEY, KATHLEEN
333 WHITTIER AVENUE
DUNELLEN, NJ 08812

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/23/1997
GOODIN, RICHARD C. (MD)
RIVERVIEW CORRECTIONAL
OGDENSBURG, NY 13669

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
GOODNIGHT, JAMES W. (MD)
535 HIGH MOUNTAIN ROAD
NORTH HALEDON, NJ 07508

NPI-1144313131
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/17/2014 4/11/2017
GOODWIN, BARBARA G. (RN)
1201 NORTH CHARLOTTE ST.
DICKSON, TN 37055

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/19/2002
GORCEY, STEVEN (MD)
32 VALLEY FORGE ROAD
EATONTOWN, NJ 07724

NPI-1679512941
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/11/2019 1/7/2021
GORDON, BARBARA (X -RAY TECH)
133 MORTON AVENUE
S. PLAINFIELD, NJ 07080

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/5/2001 Permanent
GORDON, CRAIG W. (MD)
164 RIVEREDGE DRIVE #164
CHATHAM, NJ 07928

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/2007
GORDON, CRAIG W. (MD)
8 SHERWOOD CIRCLE
LINDEN, NJ 07036

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/18/1993 Permanent
GORDON, HOWARD L. (MD)
222 BROADWAY
NEWARK, NJ 07104

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
GORDON, RAHSHEEDA (CHHA)
445 SOUTH 11TH STREET
NEWARK, NJ 07103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
GORIGANTI, MAHENDER (MD)
7187 WOODCHUCK HILL ROAD
FAYETTEVILLE, NY 13066

NPI-1144202805
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
GOROVITS, LILIA (MD)
1157 METTLER ROAD
HUNTINGTON VALLEY, PA 19006

NPI-1427163427
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2017
GORUKANTI, SURENDER (MD)
4324 BEDFORD AVENUE
BROOKLYN, NY 11229

NPI-1750488292
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2018
GORUKANTI, SURENDER (MD)
4324 BEDFORD AVENUE
BROOKLYN, NY 11229

NPI-1750488292
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2019 Permanent
GOTAY, ALEXANDER (LCSW)
SSCF, P.O. BOX 150
DELMONT, NJ 08314

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/24/2008
GOULBOURNE, MARIANA (CHHA)
430 S. 13TH STREET
NEWARK, NJ 07103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
GRANGER, MAI AKA GRIFFITHS, MAI (CHHA)
15 PEPPERMINT LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/1999 Permanent
GRANT, NICOLE (CHHA)
18 BUCKNELL DRIVE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
GRANVILLE, PEDRO JULIO (CLIN LAB TECH)
823 BROAWAY
WEST LONG BRANCH, NJ 07764

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015
GRASSER, JENNIFER B. AKA KROWICKI, JENNIFER (RN)
232 CLUB DRIVE
WALL, NJ 07719

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
GRAUERHOLZ, JOHN E. (MD)
P.O. BOX 2172
LEESBURG, VA 22075

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
GRAY, KEVIN
129 CHANCELLOR AVE
NEWARK, NJ 07112

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
GRAY-KEARLY, ASHLEE (CHHA)
10 CORAL DRIVE
HOWELL, NJ 07731

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
GRAYOVSKI, ELIZABETH (CHHA)
206 NORTHFIELD ROAD
MILLINGTON, NJ 07946

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/14/2017

THIRO AND GRAYSON INC
449 AVENUE C
BAYONNE, NJ 07002

GRAYSON, MURRAY A. (RPH)
163 HAMPTON GREEN
STATEN ISLAND, NY 10312

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
GRAZIANO, NATALE (MD)
470 BROOKSIDE LANE
SOMERVILLE, NJ 08876

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
GREEN, JOHN N. (MD)
3 PADDOCK COURT
BASKING RIDGE, NJ 07920

NPI-1114072444
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/25/2014
GREEN, JOHN N. (MD)
61 MAIN STREET
WEST ORANGE, NJ 07102

NPI-1114072444
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012 6/21/2012
GREEN, JOYCE D. (CHHA)
PO BOX 145
WOODBINE, NJ 08270

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2003
GREEN, ROBERT (MD)
22 OLD SHORT HILLS ROAD
LIVINGSTON, NJ 07039

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

9/2/1992 DECEASED
GREENBERG, ANTHONY (MD)
576 STATE ROUTE 94
COLUMBIA, NJ 07832

NPI-1487641239
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/29/2016
ORANGE DRUG & SURGICAL IN
270 HIGHLAND ROAD
S. ORANGE, NJ 07079

GREENBERG, EDMUND (RPH)
270 HIGHLAND ROAD
S. ORANGE, NJ 07079

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/7/2000 DECEASED
GREENBERG, LAUREN (LPN)
2376 WEST MAIN STREET
MILLVILLE, NJ 08332

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2019
GREENE, LIZA (RN)
57 N. RIVER DRIVE
PENNSVILLE, NJ 08070

NPI-
Vendor
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
GREENFARB, IRVING (DO)
160 LITTLETON ROAD
MORRIS PLAINS, NJ 07950

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/1988 DECEASED
GREENFIELD, RONALD W.
227 CLUB DRIVE
WALL, NJ 07719

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/19/2001
GREENLEAF, JANICE (LPN)
110 EAST JUNIPER AVENUE
NORTH WOLDWOOD, NJ 08260

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
GREENSPAN, BERNARD (DO)
484 LAFAYETTE AVENUE
HAWTHORNE, NJ 07506

NPI-1245231406
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/4/2017 Permanent
GREENSPAN, BERNARD (DO)
150 OVERLOOK AVENUE, 10C
HACKENSACK, NJ 07601

NPI-1245231406
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2017 Permanent
GREENSPAN, WILLIAM
GILL LANE
ISELIN, NJ 08830

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/27/2000
Jack Mack Commercial Roofing, Inc.
153 Lewis Street
Perth Amboy, NJ 08861

Gregorio Soto, Owner
768 Courtlandt St
Perth Amboy, NJ 08861

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/18/2015 03/17/2018
GRETZULA, CHAD (DMD)
616 EAST LANCASTER AVENUE
BERWYN, PA 19312

NPI-1558422311
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
GRIETZER, JOY (RN)
406 EAST FRANKLIN AVENUE
WEST BERLIN, NJ 08091

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/22/2017
GRIFFIN, CHARLES (RPH)
HAZELTON USP, PO BOX 2000
BRUCETON, WV 26525

NPI-1669757530
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
GRIFFIN, REMY (CHHA)
490 PARK AVENUE, APT. #3-B
PATERSON, NJ 07504

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
GRIFFITHS, MAI AKA GRANGER, MAI (CHHA)
15 PEPPERMINT LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/1999 Permanent
GRIMES, BRIDGET
293 LINCOLN STREET
PHILLIPSBURGH, NJ 08865

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/29/2012
GRINSHPUN, LEV (CHHA)
201-F MORRIS AVENUE
ELIZABETH, NJ 07208

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/22/2017
GRISSON, SANDRA
30 SOUTH CHURCH STREET, APT. 5
WAYNESBORO, PA 17268

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
GROSS, KENNETH (DC)
333 PROVINCIAL DRIVE
MORGANVILLE, NJ 07751

NPI-1740488709
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
GROSSETT II, KENNETH W. (RPH)
SOUTH DUPONT ROAD
CARNEYSPOINT, NJ 08069

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2008
GRULLON, KADIA (CHHA)
204 ACKERMAN AVENUE
CLIFTON, NJ 07011

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
GUANMESIA, EUNICE AKA MANJO, EUNICE (RN)
128 FIELDBROOK DRIVE
MAGNOLIA, DE 19962

NPI-1811443815
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
GUDE, ROBERT
9 WYCOFF TERRACE
FAIRLAWN, NJ 07410

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/6/2013 2/5/2016
GUENSCH, LISA M. (RN)
85 MORNING GLORY ROAD
WARREN, NJ 07059

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2009
GUERRERO, RAUL
110 JEROME AVENUE
SOUTH BOUND BRO, NJ

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2004
GUERRERO, THAMARA (CHHA)
327 OUTWATER LANE #2
GARFIELD, NJ 07026

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/6/2018
GUERRIERO, LU ANN M. (DC)
21 KILMER DR, STE 2A
MORGANVILLE, NJ 07751

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/24/1997
GUICE SR., JASON C.
725 ELIZABETH AVE.
NEWARK, NJ 07112

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/15/2004
GUICE, AZIE VICE PRESIDENT
725 ELIZABETH AVENUE
NEWARK, NJ 07112

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/5/2005
GUILBERT, RICARDO (LPN)
SOUTHERN STATE CORREC FAC
DELMONT, NJ 08314

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/1995 Permanent
GUILIANO, GINA (RN)
1 KINDERKAMACK ROAD
WOODCLIFF LAKE, NJ 07677

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/18/2003
GULLA, FRANK T. (MD)
113 RTE. 46 W. WILLOW SQ.
WAYNE, NJ 07470

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/7/1999 Permanent
GUPTA PHARMACY
1700 OAK TREE ROAD
EDISON, NJ 08820

GUPTA, NAVEEN (RPH)
1700 OAK TREE ROAD
EDISON, NJ 08820

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/4/1999 Permanent
GUPTA, RASHMI J. (COUNSELOR)
203 HASSE AVENUE
PARAMUS, NJ 07652

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/30/2012
GUPTA, RASHMI J. (COUNSELOR)
10913 CORY LAKE DRIVE
TAMPA, FL 33647

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/3/2013
GUPTA, ROHIT #000263228G
BAYSIDE STATE PRISON, PO BOX F-1
LEESBURG, NJ 08327

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/4/2019
GURBAN, ELHAN
14 FAHRNER STREET
BERGENFIELD, NJ 07621

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/16/2016
GURBAN, ELHAN
SOUTHERN STATE CORRECTIONAL, 4295 ROUTE 47
DELMONT, NJ 08314

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
GUREVICH, NATALIA (MD)
31-23 CRESCENT ST. APT 2C
ASTORIA, NY 11106

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2005
GUSSMAN, MICHAEL (DPM)
141 GREENBROOK DRIVE
MARLTON, NJ 08053

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
GUSTAFSON, JOHN
39 CHARLES STREET
MONTGOMERY, NY

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/10/2013 4/9/2016
GUYTON, KATHLEEN
228 SANFORD STREET
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2002
GUZZI, NICOLE (CHHA)
117 SHERIDAN AVENUE
ROSELLE PARK, NJ 07204

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/2/2018
GYAPONG, WILLIAM (CHHA)
5 LORETTO STREET
NEWARK, NJ 07112

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/29/2019
HABIB, IMAD
1529 39TH STREET 1ST FL
NORTH BERGEN, NJ 07047

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2011
EAST BROADWAY MEDICAL ASSOCIATES
195 BROADWAY
PATERSON, NJ 07505

HAIDER, MOHAMMED M.
195 BROADWAY
PATERSON, NJ 07505

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

12/7/1999
HAINES, KEITH (MD)
1210 BRACE ROAD
CHERRY HILL, NJ 08034

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

10/15/1991 DECEASED
HAINES, RAMONA L. (RN)
103 MEADOWVIEW CIRCLE
MARLTON, NJ 08053

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2004
HAINES, ROBBIE A. (RN)
WHITE POND COURT
ABSECON, NJ 08205

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2007
HAITMANEK, OTTILLIE M. (LPN)
4162 BAYBERRY COURT
MONMOUTH JUNCTION, NJ 08852

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
HALAS, JOHN
144 WHITEHALL DRIVE
VOORHEES, NJ 08043

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2002
HALL, AFRIKA AKA JACKSON, AFRIKA
BRIARWOOD DRIVE
TOBYHANNA, PA 18466

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/2/2007 6/28/2018
HALL, ANNA M. (RN)
44 LAKE TRAIL EAST
WAYNE, NJ 07470

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
HALL, KIM
5 UNAMI LANE
SCOTCH PLAINS, NJ 07076

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2009 Permanent
HUDSON MEDICAL LIVERY
100 RESERVOIR AVENUE
JERSEY CITY, NJ 07307

HAMAD, ALHIBER K.
100 RESERVOIR AVENUE
JERSEY CITY, NJ 07307

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
HAMBERG, IVAN (OD)
49 W. CHELTEN AVENUE
PHILADEPHIA, PA 19144

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/27/2001 Permanent
HAMDAN, AIMAN (MD)
7 OAK HILL DRIVE
WAYNE, NJ 07470

NPI-1336186600
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2018
HAMDAN, KRISTINA
7 OAK HILL DRIVE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/16/2017
HAMDAN, KRISTINA #70919-050
ALDERSON FPC, GLEN RAY ROAD, BOX A
ALDERSON, WV 21910

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/4/2019
ANDAS PHARMACEUTICAL SUPPLY CORP.
592 PALISADE AVENUE
TEANECK, NJ 07666

HAMED, AHMED
592 PALISADE AVENUE
TEANECK, NJ 07666

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2018
HAMENOO, LOVESDALE AKA ADADEVOH, LOVESDALE (CHHA)
1 SKYTOP GARDENS, APT. 19
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2019
HAMM, CARRIE (RN)
1134 N. STILES STREET
LINDEN, NJ 07036

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/23/2010 2/23/2013
HAMM, CARRIE (RN)
1134 N STILES STREET
LINDEN, NJ 07036

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003 2/23/2013
HAMPTON, GLYNDA
571 MONTGOMERY STREET
JERSEY CITY, NJ 07302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/29/2002 Permanent
HAN, DANIEL
481 WALKER STREET, APT. 1D
FAIRVIEW, NJ 07022

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/29/2016
HANDERHAN, LEROY (RN)
909 ABINGTON ROAD
CHERRY HILL, NJ 08034

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2007
HANDS, EVELYN (CHHA)
789 WHEATLAND COURT
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/27/2006
HANNA, ALEXANDRA (LPN)
51 NORTHRUP DRIVE
BRICK, NJ 08724

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2018
HANNA, ASHRAF (PHARM TECH)
50 WILLETT AVENUE
SOUTH RIVER, NJ 08882

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
HANNAN, SR., PAUL (MD)
6619 WALLASTON COURT
BROOKLYN, NY 11204

NPI-1639166572
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/15/2021
HANSCOM, CRYSTAL (RPH)
1407 BROMLEY ESTATES
PINE HILL, NJ 08021

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/8/2011 9/6/2016
HARLOW, ALBERT J.
515 SUMMIT LANE
RIEGELSVILLE, PA 18077

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/22/2013 4/21/2016
Harold Marshall, Jr., Member
1800 Eva Street
Austin, TX 78704

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/12/2014 05/11/2017
HARPER, JENNIFER R. (RN)
131 HEMLOCK COURT
WOODBURY, NJ 08096

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
HARRELL, PAMELA L. (RN)
1150 REDROCK CANYON RD
KATY, TX 77450

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2002
HARRIGAN, DAVID C. (DC)
161 W. WHITE HORSE PIKE
ABSECON, NJ 08201

NPI-1932155736
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/1995
HARRIS, JOHNNIE
2 LAKE BLVD
EWING, NJ 08638

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/22/2006 Permanent
HARRIS, PAUL AKA PATEL, HARISH (MD)
GB-46 PO BOX 26010
BEAUMONT, TX 77720

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
HARRISON, RONISHA (CHHA)
96 KNIGHTS BRIDGE WAY
MAYS LANDING, NJ 08330

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/9/2018
HARRIS-POOLE, IRENE (PTA)
708G LUCAS LANE
VOORHEES, NJ 08043

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/20/2003
Harry Gallo, Secretary
245 Emanuel St.
Trenton, NJ 08610

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/5/2016 4/4/2019
HARVILIK, DOROTHEA (RN)
20 EAST ALLENDALE ROAD
SADDLE RIVER, NJ 07458

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017 Permanent
HASSAN, SALAH A.
105 TONNELLE AVENUE
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/31/2001 Permanent
HASSETT, IRENE (PHD)
950 MORGAN HIGHWAY 226
SOUTH ABINGTON, PA 18411

NPI-1801894803
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
HATCHER-MURPHY, KIMBERLY AKA HURBAN, KIMBERLY (LPN)
966 HERMAN DRIVE
DEPTFORD, NJ 08051

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2018
HEGGS, PAMELA B.
P.O. BOX 4004
CLINTON, NJ 08809

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2007
HEIGEL, GEORGE
350 MAIN STREET
KERSEY, PA 15846

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/30/2013 5/29/2016
E & S ENTERPRISES, LLC
PO Box 2050
Vineland, NJ 08360

HELEN HENRIQUEZ, OWNER
101 South Orachard Rd
Vineland, NJ 08360

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/28/2016 1/27/2019
HELLER, ELLIOT M. (MD)
1150 AMBOY AVENUE
EDISON, NJ 08837

NPI-1770688723
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/29/2003 6/25/2014
HENRIQUEZ, HELEN
101 S. ORCHARD ROAD
VINELAND, NJ 08360

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/28/2016 1/27/2019
HENRY, SARA (RN)
54 CARVER AVENUE
LINDENWOLD, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/7/2008
HERMAN, LAWRENCE S. (DC)
8908 DANVILLE TERRACE
FREDERICK, MD 21701

NPI-1881664761
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
HERMAN, THERESA (RN)
676 HARBOR ROAD
BRICK, NJ 08724

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
HERNANDEZ, JENNIFER OFELIA (CHHA)
1410 OAK TREE DRIVE (H)
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/25/2013
HERNANDEZ, NORA LEE (LPN)
4820 OLD HARRISBURG ROAD, LOT 27
GETTYSBURG, PA 17325

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
HERNANDO, GILDA
669A CHAMBERS STREET
TRENTON, NJ 08611

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/8/2002
HERSCHMAN, ZVI J. (MD)
1 OLD SHORT HILLS ROAD
LIVINGSTON, NJ 07039

NPI-1033217492
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/28/2013
HERSCHMAN, ZVI J. (MD)
346 WILSON STREET
WEST HEMPSTEAD, NY 11552

NPI-1033217492
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2013
HERSHAN, DAVID (MD)
33 OWATONNA STREET
HAWORTH, NJ 07641

NPI-1740280957
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2017
HESSEIN, AMGAD A. (MD)
483 SOUTH ORANGE AVENUE
SOUTH ORANGE, NJ 07079

NPI-1578637260
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/26/2012 5/25/2016
HESSEIN, AMGAD A. (MD)
24 DOGWOOD COURT
WOODLAND PARK, NJ 07424

NPI-1578637260
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/25/2016
HESSEIN, AMGAD A. (MD)
BAYSIDE STATE PRISON, PO BOX F-1
LEESBURG, NJ 08327

NPI-1578637260
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/1/2017
HEYMACH, GEORGE (MD)
801 W. 57TH TERRACE
KANSAS CITY, MO 64113

NPI-1568588317
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/27/2001 Permanent
HEYMAN, JACK (DO)
124 E MT PLEASANT AVENUE
LIVINGSTON, NJ 07039

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/7/1983 DECEASED
HIBBS, ELIZABETH AND ELIZABETH O'BRIEN
2201 BENJAMIN FRANKLIN PARKWAY, APT. 807
PHILADEPHIA, PA 19130

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
HICKS, MYASIA (CHHA)
38-40 JOHNSON AVENUE
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/8/2017
HIGGINS, GARY W. (RN)
548 WAYSIDE ROAD
NEPTUNE, NJ 07753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
HIGGINS, MARTIN
706 BLOOMFIELD AVENUE
NUTLEY, NJ 07110

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2005
HIGGINS, RANDALL T. (RPH)
17 WAVERLY PLACE
MATAWAN, NJ 07747

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017
HILLA,ALAN
612 CHEROKEE LANE
BRIELLE, NJ 08730

NPI-
Vendor
Criminal Offense

Law and Public Safety
1020

6/6/2017 6/6/2027
HILLEY, KATHLEEN M.
219 CENTER STREET
TUCKERTON, NJ 08087

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/15/2010
HILT, JOE PRESIDENT
79 MYRTLE AVENUE
MICKELTON, NJ 08056

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/23/2012 8/22/2015
HILTON JR., JAMES R. (DO)
28 BROCKTON COURT
BEACON FALLS, CT 06403

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/3/2002
HIMMELWRIGHT, VICTOR
44 LONDONBERRY WAY
SUMMIT, NJ 07901

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
HINSON, ANTHONY (RN)
566 RECTOR STREET
PHILADEPHIA, PA 19128

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/21/2020
HIRES, STEPHANIE (RN)
725 FORD AVENUE
LANGHORNE, PA 19047

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2018
HIRSH, HOWARD (RPH)
163 EINSTEIN WAY
EAST WINDSOR, NJ 08512

NPI-1811204605
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
HO, SHING (MD)
6 JAMOR COURT
NESCONSET, NY 11767

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2000
HOCHBERG, JOHN (MD)
288 PLEASANT VALLEY ROAD
MORGANVILLE, NJ 07751

NPI-1134280480
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/14/2016
HOCHBERG, JOHN (MD)
288 PLEASANT VALLEY ROAD
MORGANVILLE, NJ 07751

NPI-1134280480
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2017
HODGKISS, KATHLEEN (PSYCH)
151 KNOLLCROFT ROAD
LYONS, NJ 07939

NPI-1013179233
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/22/2017
HOFFMAN, KATHLEEN AKA SULIMENKO-HOFFMAN, KATHLEEN (LPN)
99 CREEK ROAD
BRICK, NJ 08724

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/13/2018
HOFFMAN, MARTIN L. (MD)
7 CAREFREE LANE
SUFFERN, NY 10901

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/29/2002
HOFFSPIEGEL, PAUL
56 SULLLIVAN DRIVE
WEST ORANGE, NJ 07052

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/6/1998
HOFSTETTER, DAVID OWNER
114 COUNTY ROAD 513
PITTSTOWN, NJ 08867

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/14/2000
HOLCA, LIVIU (MD)
1137 BEACON AVENUE
MANAHAWKIN, NJ 08050

NPI-1053348417
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/25/2014
HOLLEY, AKEYA (CHHA)
11 MONTICELLO AVENUE, 2ND FLOOR
NEWARK, NJ 07106-

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/13/2018
HOLLOWAY, JAZMINE (CHHA)
95 CUMMINGS AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
HOLLOWAY, LAKEZIA (CHHA)
1306 SUMMERFIELD AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/13/2018
PARTNERS FOR HOPE
447 EAST 42ND STREET
PATERSON , NJ 07504

HOLLOWAY, QUINCEY (LSW)
447 EAST 42ND STREET
PATERSON, NJ 07504

NPI-1689883001

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/2019 4/24/2019
HOLMES, THERESA (CHHA)
1290 N. 27TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/12/2018
HOMAN, WALTER W. (CHHA)
FORECASTLE AVENUE
BEACHWOOD, NJ 08722

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/21/2008
HONG, JOSEPH S. (MD)
34 FOREST DRIVE
WATCHUNG, NJ 07069

NPI-1346258001
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2016
HOPKINS, TANYA (CHHA)
433 EAST 18TH STREET, 2ND FLOOR
PATERSON, NJ 07524

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2019
HOPPE, GERALD
BOX 483A RD 1
MONROEVILLE, NJ 08343

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
HORN, MURRAY
287 GARFIELD AVE
HAWORTH, NJ 07641

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/19/1984 Permanent
HORVATH, CHARLYN (RN)
3072 BORDENTOWN AVENUE
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2018
HORWITZ, KENNETH (RPH)
8 MOHAWK PLACE
RANDOLPH, NJ 07869

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/31/2003 7/20/2011
HOUSTON, PLATINUM (CHHA)
15 COURTLAND LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2017
HOUTAN, FARAH (PTA)
269 STEELMANVILLE ROAD
EGG HARBOR, NJ 08234

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/1/2012
HOUTAN, FARAH (PTA)
269 STEELMANVILLE ROAD
EGG HARBOR TOWN, NJ 08234

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/27/2009
HOWARD, REGINA R.
104 E. 8TH STREET
LAKEWOOD, NJ 08701

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/30/2013
HOWARD, ROBIN A. (RN)
196 KING AVENUE
TRENTON, NJ 08638

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001 Permanent
HOWELL, BRIAN (LPN)
106 PARKER AVENUE #2
FORKED RIVER, NJ 08731

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/27/2017
HOWELL, CHRISTOPHER (CHHA)
978 JOLSON COURT
MANCHESTER TOWNSHIP, NJ 08759

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/26/2017
HOWELL, CLIFTON (MD)
15 COLONY DRIVE WEST
WEST ORANGE, NJ 07052

NPI-1942247622
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/19/2011
HOWELL, CLIFTON (MD)
15 COLONY DRIVE WEST
WEST ORANGE, NJ 07052

NPI-1942247622
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/18/2012
HRABARCHUK, EUGENE (MD)
925 CLIFTON AVENUE
CLIFTON, NJ 07013

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
HSIA, VINCENT (RPH)
SCHUYLKILL FCI
MINERSVILLE, PA 17954

NPI-1710209291
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/1/2014
HU, HSUN TUAN
154 HOMESTEAD PLACE
BOGOTA, NJ 07603

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/10/1999 Permanent
HUBBARD, PETER (RN)
1051 WASHINGTON STREET, APT. 4
EASTON, PA 18042

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
HUDSON, FITZGERALD (MD)
PO BOX 1000
MILAN, MI 48160

NPI-1639367725
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

6/12/2014
HUERTA JR., FRANK
25 CHAPEL STREET
BROOKLYN, NY 11201

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/10/1997
HFC Painting
696 Elm St
Kearny, NJ 07032

Hugo Canabe, CEO
696 Elm St
Kearny, NJ 07032

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/18/2015 03/17/2018
DM FERNANDES CONTRACTS, LLC
551 North Broad St
Elizabeth, NJ 07208

Hugo Fernandes, Owner
90 Willow Street
Cartaret, NJ 07008

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/28/2015 1/27/2018
HUNDA, RAFAEL (MD)
472 RIVER STREET
PATERSON, NJ 07524

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/21/2001 Permanent
HUNTER, CHRISTOPHER (LPN)
430 BARTINE STREET
SOMERVILLE, NJ 08876

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2002
HUNTER, FRANK L.
6 HARTZ DRIVE
BRIDGETON, NJ 08302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2005
HURBAN, KIMBERLY AKA HATCHER-MURPHY, KIMBERLY (LPN)
966 HERMAN DRIVE
DEPTFORD, NJ 08051

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2018
HURLEY, DOUGLAS #65501-050
FCI FAIRTON #66214-050, PO BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
Jamali Developers, LLC SUSPENDED PENDING DEBARMENT
553 Main Street
North Brunswick, NJ 08902

Hussain Burhanpurwala, Member
238 Fresh Ponds Rd Suite 100
Monroe, NJ 08816

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/0/1900 SUSPENDED
HUSSAIN, IFTIKHAR
9 VAN COURTLAND AVENUE
STATEN ISLAND, NY 10301

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2003 Permanent
HUSSAIN, ZAHID (MD)
301 ROUTE 9 NORTH
FREEHOLD, NJ 07728

NPI-1992733232
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/30/2011 7/22/2016
HUSSKE, JULIE (RN)
1105 CRENDALL WAY
WAKE FOREST, NC 27587

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/10/2019
HUSTON JR., JOHN A. DN2591 (CHHA)
8 PRODUCTION WAY
AVENEL, NJ 07001

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/29/1997
HYMAN, DEBORAH
6 HASTINGS LANE
FLEMINTON, NJ 08822

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2006
HYMAN, RONALD M. (RPH)
3845 DEMPSEY
HUNTINGTON VALLEY, PA 19006

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2005
IBRAHIM, ELHADI
125 HALF MILE RD, BOX 190
MIDDLETOWN, NJ 07748

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/29/2001 Permanent
ATA MEDICAL TRANSPORTATION
55 WASHINGTON STREET, SUITE 600
EAST ORANGE, NJ 07017

IBRAHIM, GASIM
340 FAIRMOUNT
JERSEY CITY, NJ 07306

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/11/1996 Permanent
IBRAHIM, MOHAMMAD (MD)
871 MCBRIDE AVENUE
WOODLAND PARK, NJ 07424

NPI-1265494645
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/22/2016
IGBERASE, OLUWAFEMI AKA IGBERASE, CHARLES AKA AKODA, CHARLES (RN)
14909 DOWNEY COURT, SUITE 200
BOWIE, MD 20721

NPI-1609033042
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2018
IGBINADUWA, NEWTON (RPH)
116-35 139TH STREET
JAMAICA, NY 11436

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
IGHAMA-AMEGOR, IBIOLA (MD)
59 MAPLE AVENUE
VAUXHALL, NJ 07088

NPI-1639251804
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/16/2017
IGHAMA-AMEGOR, IBIOLA (MD)
204 KEER AVENUE
NEWARK, NJ 07112

NPI-1639251804
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
IGNACCOLO, EMANUELE (MD)
688 WYCHOFF AVENUE
MAHWAH, NJ 07430

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
IKEH, CHIDI ETHELBERT
PO BOX 26030
BEAUMONT, TX 77720

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/9/2008
ILEM, PRISCILLA G. (MD)
782 ALPS ROAD
WAYNE, NJ 07470

NPI-1699860684
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/27/2013
ILLINGWORTH, DONNA (LPN)
1505 CLAIRE ROAD
FORKED RIVER, NJ 08731

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
INGALLS, ANDREA (CHHA)
36 NORWOOD STREET, 3RD FLOOR
NEWARK, NJ 07106

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
INNES JR., GEORGE MICHAEL (MD)
1736 EAST GENESEE STREET
FAYETTEVILLE, NY 13066

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2005
Envirocare Enterprises, Inc.Envirocare Enterprises, Inc.
658 Rutgers Pl
Paramus, NJ 07652

Inno Obiorah, Manager
358 Broadway Suite 202
Newark, NJ 07104

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/16/2014 05/15/2017
INNOCENZI, ANTHONY (DPM)
7972 AQUADALE DRIVE
YOUNGSTOWN, OH 44512

NPI-1255336079
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
INSABELLA, HARRY (DDS)
591 SOMERSET ST.
SOMERSET, NJ 08873

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/1/1997 Permanent
INTELISANO, RONALD (DO)
46 BUCKINGHAM DRIVE
BERLIN, NJ 08009

NPI-1235200775
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017
INTELISANO, RONALD (DO)
1504 BLACKWOOD CLEMENTON ROAD
BLACKWOOD, NJ 08012

NPI-1235200775
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2017
IOSIM, ANATOLY (CHHA)
9217 FALSTON CIRCLE
OLD BRIDGE, NJ 08857

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/20/2017
IQBAL, MOHAMMED S. (MD)
LINWOOD AVENUE
RIDGEWOOD, NJ 07450

NPI-1972564078
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/12/2008
IRBY, ARCHER (DC)
115 GRAND AVENUE
ENGLEWOOD, NJ 07631

NPI-1801927520
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
Euro Construction
70 Bordentown-Chesterfied
Chesterfield, NJ 08022

Ireneusz Waluk, Owner
70 Bordentown Chesterfield Rd
Chesterfield, NJ 08022

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/25/2014 02/24/2017
IRVING, EDWARD J.
202 SEYMOUR AVENUE
NEWARK, NJ 07108

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2004
ISAACSON, STEVEN (RPH)
1959 BIRCHWOOD PARK DRIVE
CHERRY HILL, NJ 08034

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/6/1995 Permanent
ISLAMBEKOV, ALLANUR
11 ARBORETUM DRIVE
JACKSON, NJ 08527

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/12/2014 5/11/2017
ISMAIL, MOHAMMAD (RPH)
4 GRAHAM COURT
PARSIPPANY, NJ 07054

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/18/2003
IVASHENKO, ALEXANDER (PT)
31 GOLDSMITH DRIVE
HOLMDEL, NJ 07333

NPI-1134289796
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/25/1999
IYENGAR, DEVARAJAN (MD)
27 EAST 29TH STREET
BAYONNE, NJ 07002

NPI-1689620700
Medical
Antitrust/Anti-Kickback Acts
Suspension

Human Services
Medical Assistance (Medicaid)

8/25/2015 1/10/2017
JACKSON, AFRIKA AKA HALL, AFRIKA
BRIARWOOD DRIVE
TOBYHANNA, PA 18466

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/2/2007 6/28/2018
JACKSON, AMINATU (CHHA)
26 JAMES STREET, C12
LAKEWOOD , NJ 08701

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
JACKSON, DESHONETTE (CHHA)
419 EAST 27TH STREET, 2ND FLOOR
PATERSON, NJ 07515

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
JACKSON, GEORGE D. (PSYCH)
367 FAIRVIEW AVE.
ORANGE, NJ 07050

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/1997 Permanent
JACKSON, MAKEBA (CHHA)
15 MILL STREET
EATONTOWN, NJ 07724

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
JACKSON, ZEKIA (CHHA)
232 JUSTIN WAY
WILLIAMSTOWN, NJ 08094

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/19/2017
JACKSON-GILLARD, CRYSTALYNN (CHHA)
3 BORDEN AVENUE, APT. 8
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/24/2018
JACOBS, AMY (LPN)
620 MOUNTAIN ROAD
BUTLER, NJ 07405

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
JACOBS, ROSS M.
15 MAST DRIVE
BARNEGAT, NJ 08005

NPI-
Vendor
Industry Law Violation
Suspension

Treasury
Treasury Purchase Bureau

10/12/2004
JACOBSON, CRAIG (DC)
1219 LIBERTY AVENUE
HILLSIDE, NJ 07205

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/24/2000 DECEASED
JACOBSON, DEBRA
661 RT. 9
BAYVILLE, NJ 08721

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/25/2011 1/25/2013
JACOBSON, JAY P. (DC)
25 DEER PATH
HOLMDELL, NJ 07733

NPI-1508084385
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/12/1996 Permanent
JACQUES, ARNOLD J. (MD)
31 BRIDGEWATER COURT
JACKSON, NJ 08527

NPI-1124170899
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/30/2011
JACQUEZ, MADELIN (CHHA)
2141 SOUTH CLINTON AVENUE
HAMILTON, NJ 08610

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/12/2018
JAFARI, MARYAM (MD)
80 LINDEN STREET APT. M
MILLBURN, NJ 07041

NPI-1831276880
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2014
JAFARI, MARYAM (MD)
176 BLOOMFIELD AVENUE
NEWARK, NJ 07104

NPI-1831276880
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012
JAFFERY, SYED (MD)
109 TROTTER ROAD
EGG HARBOR, NJ 08234

NPI-1235153685
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/15/2016
JAGTIANI, RAJA (MD)
10 ONTARIO STREET
DUMONT, NJ 07628

NPI-1659320281
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/6/2016 11/29/2016
JAGTIANI, RAJA (MD)
10 ONTARIO STREET
DUMONT, NJ 07628

NPI-1659320281
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/28/2015
JAKUBCZAK, ARTHUR F. (DC)
465 RATHBURN PLACE
PERTH AMBOY, NJ 08861

NPI-1053493718
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/18/2001 10/26/2001
JC Builders
610 County Meadows Road
Nicholls, GA 31554

James Chaney, President
610 County Meadows Road
Nicholls, GA 31554

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/11/2015 08/10/2018
James DiLorenzo, Vice-President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/3/2016 2/2/2019
Perrone Trucking LLC
74 Glen Roy Road East
Fairfeild, NJ 07004

James Perrone, Owner
74 Glenroy Road East
Fairfield, NJ 07004

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/28/2015 10/27/2018
The Grace Brothers
14 Surrey Lane
Williingboro, NJ 08046

James T. Grace, Owner
311 Colonial Road
Edgewater Park, NJ 08010

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/9/2014 01/08/2017
Top Notch Tree & Landscape, LLC
46 Tam O Shanter Rd
Mahwah, NJ 07430

James Van Wyckhouse, Owner
70 East Allendale Rd
Saddle River, NJ 07458

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/7/2015 12/06/2018
JAMES, EDWARD (DO)
505 GROVE STREET
SEWICKLEY, PA 15143

NPI-1598789703
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
JAMES, GLORIA M. (RN)
18 LINDEN COURT
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2005
JAMES, SULENNY (CHHA)
293-295 BROAD STREET, 2ND FLOOR
NEWARK, NJ 07104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/27/2017
JAMISON, ROBERT W. (DO)
79 PARTRIDGE LANE
CHERRY HIL, NJ 08003

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/11/2000 Permanent
JANKULOSKI, MARIA
4 QUARTZ LANE
PATERSON, NJ 07501

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/10/2014 6/9/2017
JANOF, ROY
502 WASHINGTON STREET
HOBOKEN, NJ 07030

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/9/1983 Permanent
JANVIER-PIERRE, MARY
6400 BRIDGEPORT LANE
LAKE WORTH, FL 33463

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2012
JARMON, ROBERT G. (MD)
8 BRIGHTON AVENUE
SPRING LAKE, NJ 07762

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/9/2002
JASCALEVICH, MARIO E. (MD)
10 PRISCILLA LANE
ENGLEWOOD CLIFF, NJ 07632

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
JASINSKI, DARIUS (DPM)
1225 MCBRIDE AVENUE
WOODLAND PARK, NJ 08424

NPI-1013995182
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/29/2016 9/22/2020
JASPER, SARAH (CHHA)
187 SIERRA COURT
WOODBRIDGE, NJ 07095

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
JASPER, THEODORE (MD)
1010 CLIFTON AVENUE
CLIFTON, NJ 07013

NPI-1528171972
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
JASPER, THEODORE (MD)
1010 CLIFTON AVENUE
CLIFTON, NJ 07013

NPI-1528171972
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/12/2015
JASZCZULT, JOAN E. (DO)
50 NEWARK AVENUE, APT 309
BELLEVILLE, NJ 07109

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/3/2006
JAVID, MOHAMMAD A.
E. JERSEY STATE PRISON
RAHWAY, NJ 07065

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2000
JAVID, MOHAMMAD A.
63 FEDERAL STREET
METUCHEN, NJ 08840

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/11/1996 Permanent
JAYARAM, AJIT (MD)
215 SOUTH BURLINGTON ROAD
BRIDGETON, NJ 08302

NPI-1295773869
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2013
JAYARAM, AJIT (MD)
215 SOUTH BURLINGTON ROAD
BRIDGETON, NJ 08302

NPI-1295773869
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/4/4014
JEAN-BAPTISTE, DEMESVAR A. (MD)
775 MOUNTAIN BLVD STE 1
WATCHUNG, NJ 07069

NPI-1831227719
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2011 DECEASED
Twin Industries
15 Lewis Street
Eatontown, NJ 07724

Jeanne Crispino, Vice-President
15 Lewis Street
Eatontown, NJ 07724

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/5/2016 04/04/2019
JECK, CHARLES N. (DO)
1 CHICKORY PLACE
NEWTOWN, PA 18940

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

7/5/2002
JEDJU, LINDA (CHHA)
33 NINTH STREET, PO BOX 644
FLAGSTOWN, NJ 08824

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/27/2016
JEFFERSON, MICHAEL K. (DMD)
408 PADDOCK COURT
SEWELL, NJ 08080

NPI-1811956238
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/16/2016 5/12/2017
Turfscapes LLC
3477 S. Blackhorse Pike
Williamstown, NJ 08094

Jeffrey Grize, Owner
PO Box 950
Williamstown, NJ 08094

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/28/2014 05/27/2017
JEFFRIES, MARC
2 MILLER LANE
WHITEHOUSE STAT, NJ 08889

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/13/2014
JELKS, SAMARRA (CHHA)
3309 RIDGEWAY ROAD
MANCHESTER TOWNSHIP, NJ 08759

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
JEMINI, DAVID
PO BOX 280, HWY. 698
FAIRTON, NJ 08320

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
JEMINI, JACK
PO BOX 600
ELGIN, FL 32542

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
Saravia Concrete Pumping Corp.
223-10 113th St
Queens Village, NY 11429

Jerson Saravia, Owner
223-10 113th St
Queens Village, NY 11429

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/19/2013 08/18/2016
Jethro Grace Jr., Owner

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/9/2014 01/08/2017
JIBEAU, GUY
40 ENTERPRISE AVENUE
TRENTON, NJ 08638

NPI-
Vendor
Failure to Perform
Debarment

Treasury
Treasury Purchase Bureau

4/10/2013 Permanent
JIMENEZ, CRISTIAN (RN)
61 CHESTNUT STREET, APT. 3C
ONEONTA, NY 13820

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/10/2019
JIMENEZ, JOSE (COUNSELOR)
EXTENSION VILLA RITA
SAN SEBASTIAN, PR 00685

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/8/2003 12/8/2011
JOACHIM, LEONARD (MD)
26 LAKE DRIVE
MOUNTAIN LAKES, NJ 07046

NPI-1720023005
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/5/1997 Permanent
JOACHIM, LEONARD (MD)
25 HIDEAWAY LANE
SPARTA, NJ 07871

NPI-1720023005
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/5/2017
JOACHIM, STEPHANEM (CHHA)
15 LINDSLEY PLACE, APT. 1R
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
JODELKA, ERIK (RPH)
391 BEECROFT PLACE
OAKHURST, NJ 07755

NPI-1003103946
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/20/2006 2/23/2011
J.D.S Electric, Inc.
149 Montross Ave
Rutherford, NJ 07070

Joe DeSalvo, Jr., Owner
149 Montross Ave
Rutherford, NJ 07070

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/7/2015 01/06/2018
Metal Fab Atlantic LLC
1086 Mays Landing Rd
Somers Point , NJ 08234

John Dever, Owner
353 Zion Road
Egg Harbor Twp, NJ 08234

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/22/2015 01/21/2018
Precise Builders LLC
402 Market St
Newark, NJ 07105

John Domingues, Owner
402 Market St
Newark, NJ 07105

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/28/2014 05/27/2017
John Ettere, Owner
1453 Tooz Place
South Plainfield, NJ 07080

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/5/2016 1/4/2019
Garza Contracting LLC
768 Chambers Street
Trenton , NJ 08619

John Garza, Owner
768 Chambers Street
Trenton, NJ 08619

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/28/2014 04/27/2017
D & B Partners LLCsame
89 Jeanne Court
Stamford, CT 06905

John Giannattasio, Member
89 Jeanne Court
Stamford, CT 06905

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/9/2013 08/08/2016
Advantage Contracting & Entertainment Services Inc
319 Terrace Street
Rahway, NJ 07065

John H. Madara, President
319 Terrace St
Rahway, NJ 07065

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/8/2015 05/07/2018
J&D Plumbing & Heating Inc.
193 Natrona Avenue
Mercerville, NJ 08619

John J. Benedetti Jr., President
193 Natrona Avenue
Mercerville, NJ 08619

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/2/2015 11/01/2018
Mullen & Sons Contractors, Inc.
45 Fairfield Place
West Caldwell, NJ 07006

John Mullen, Jr., Owner
PO Box 773
West Caldwell, NJ 07006

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/1/2016 02/28/2019
John Mullen, Sr, President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/1/2016 2/28/2019
Ocean Blue Builders LLC
140 Harrison Ave
Fair Haven, NJ 07704

John Riley Jr, Managing Member
711 Carol Ave
Oakhurst, NJ 07755

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/6/2014 11/05/2017
Jamcon Construction LLC
6 Justa Lane
Cherry Hill, NJ 08003

John Schiavo, Managing Member
100 Springdale Road
Cherry Hill, NJ 08003

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/13/2014 01/12/2017
Barzzini Construction
65 Fern St
Browns Mills, NJ 08015

John Sorrentino, Owner
65 Fern Street
Browns Mills, NJ 08015

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/16/2014 09/15/2017
JOHNSON, ALICIA (LPN)
20 SKYTOP GARDENS
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
JOHNSON, BEVERLY (CHHA)
909 ARMSTRONG BOULEVARD, APT 3A
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/17/2018
JOHNSON, BRENDA C. (LPN)
232 OAK STREET
WILLIAMSTOWN, NJ 08094

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2003
JOHNSON, CALLISHA (CHHA)
1250 PRINCESS AVENUE
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2019
JOHNSON, DEMETRIA (CHHA)
21 ROSA PARK BOULEVARD
PATERSON, NJ 07524

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/31/2017
JOHNSON, DENISE M. (RN)
12 SIOUX TRAIL
DENVILLE, NJ 07834

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2005
JOHNSON, DUWANA L. (CHHA)
213 MARTIN LUTHER KING DR
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/14/2005
JOHNSON, HENRY (OWNER)
1258 N. EAST AVENUE
VINELAND, NJ 08360

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/25/2013 1/24/2016
JOHNSON, JULIE ANN (CHHA)
1145 MANTUA PIKE
MANTUA, NJ 08051

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2001
JOHNSON, KIM E. (LPN)
68 JANS WAY
BYRAM TOWNSHIP, NJ 07821

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/16/2017
JOHNSON, LARHONDA (CHHA)
1704 CENTENNIAL VILLAGE
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
JOHNSON, MICHAEL (LPN/RN)
899 DIANE COURT
WOODBRIDGE, NJ 07095

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
JOHNSON, ROBERT
1608 4TH AVE.
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/6/2006
JOHNSON, SHYKIRA (CHHA)
152 BELMONT AVENUE, APT. 2
PATERSON, NJ 08522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/28/2018
JOHNSTON, JAMES
25 IRELAND BROOK DRIVE
NORTH BRUNSWICK, NJ 08902

NPI-
Vendor
Criminal Offense

Law and Public Safety
1020

6/6/2017 6/6/2027
JOHNSTON, KELLIE (RN)
1697 SYLVAN DRIVE
BLUE BELL, PA 19422

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
JOHNSTON, MICHAEL #MX4261 (MFT)
SCI CAMP HILL, PO BOX 200
CAMP HILL, PA 17001

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2017
Warbeck Construction Group LLC
680 West Pine Brook Road
Lincoln Pakr, NJ 07035

Jon J Warbeck, President
63 Beaver Brook Rd Suite 305
Lincoln Park, NJ 07035

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/1/2016 02/28/2019
Jonathan Ettere, President
7 Craig Road
Readington, NJ 08853

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/5/2016 1/4/2019
JONES, ANIECE (LPN)
625 DREXEL AVENUE
ATLANTIC CITY, NJ 8401

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/4/2018
JONES, CYNTHIA R. (RN)
1089 HAWSER AVENUE
MANAHAWKIN, NJ 8050

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2002
JONES, DAVID (LPN)
97 LINCOLN PARK
NEWARK, NJ 07102

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2003
JONES, IMAJE (CHHA)
287 ABLETT VILLAGE
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
JONES, JASMINE (CHHA)
304 ERIAL ROAD
SICKLERVILLE, NJ 08081

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
JONES, KEVIN (PHARM TECH)
734 STERLING STREET
PLAINFIELD, NJ 07062

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017
JONES, MICHELLE N.
446 PROSPECT STREET-B16
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/30/2005 11/25/2019
JONES, ROSALIN (CHHA)
159 PFEIFFER STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
JONES, VANESSA (CHHA)
156 NORTH 18TH STREET
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2018
JONES-HATTOH, CHATIQUA (CHHA)
3 ROANOKE AVENUE, APT. 2C
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
JONES-PRICE, ANTIONETTE
PO BOX 1006
WENDELL, NC 27591

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/2000 Permanent
JONES-PRICE, ANTOINETTE
120 S. 20TH STREET
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/16/1998 Permanent
K & J Drywall Contractor, Inc.
68 Westervell Ave
Plainfield, NJ 07060

Jonny Ayala, Owner
705 Taft Ave
North Plainfield, NJ 07063

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/17/2016 03/16/2019
JOO, EUI D. (MD)
29 TIP TOP WAY
BERKELEY HGHTS, NJ 07922

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

10/14/1985 Permanent
JORDAN, SANDRA (LPN)
15 CANIS COURT
SEWELL, NJ 08080

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
JOSE, DELIA V.
185 S.EUCLID ST, SUITE 111
PASADENA, CA 91101

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/22/1997
J & B Plumbing LLC
11 Hummingbird Way
Jackson, NJ 08527

Joseph Battista, Owner
644 Cross Street
LAKEWOOD, NJ 08701

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/4/2015 05/03/2018
Joseph Csakvary, Inc.
163 Breakneck Road
Highland Lakes, NJ 07422

Joseph Csakvary, President
163 Breakneck Road
Highland Lakes, NJ 07422

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/4/2013 11/03/2016
Niceta Electric
2119 Merritt Drive
Northfield, NJ 08225

Joseph Niceta, Owner
2119 Merritt Drive
Northfield, NJ 08225

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/20/2015 10/19/2018
JOSEPH, ALEX (CHHA)
1531 SEWALL AVENUE, #2
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/26/2018
JOSHI, JAYENDRA B.
95-05 37TH AVE., APT 1-A
JACKSON HEIGHTS, NY 11373

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/4/1997 Permanent
JOSHI, KAJALBEN (LPN)
476 EBONY TREE AVENUE
GALLOWAY, NJ 08205

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/12/2018
JOSS, ETHAN E.
111 9TH AVENUE
HADDON HEIGHTS, NJ 08035

NPI-
Construction
Criminal Offense
Debarment

Treasury
Treasury Property Management and Construction

6/29/2007 Permanent
JOY, RENEE (RN)
34 LUTHER ALLEN LANE
BRUSH CREEK, TN 38547

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/16/2017
JOYNER, VALERIA (CHHA)
19 SCHIRRA DRIVE
WANAQUE, NJ 07465

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/18/2018
Camelot Roofing, LLC
1455 St. George Ave.
Roselle, NJ 07203

Juan J. Barquero, Owner
533 South 5th Street
Elizabeth, NJ 07206

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/18/2015 02/17/2018
Super Stars Construction Inc
58 Steiner Ave.
Neptune City, NJ 07753

Juan Riano, Owner
58 Stiner Ave
Neptune City, NJ 07753

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/12/2014 08/11/2017
JUISTON, PEGGY A.
17 MYRTLE AENUE
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2000 Permanent
Julio Pereira, Vice-President

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/17/2014 10/16/2017
JUNGER, SYLVAIN S. (MD)
270 PENNINGTON AVENUE
PASSAIC, NJ 07055

NPI-1497975551
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2011
JUODENKO, ANDREW
949 SPRING VIEW DRIVE
SOUTH HAMPTON, PA 19114

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/25/2012 10/24/2015
JUPITER, RONALD (DDS)
119 EYLAND AVENUE
SUCCASUNNA, NJ 07876

NPI-1023125879
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/5/2014
JUPITER, RONALD (DDS)
111 EAST DEWEY AVENUE APT 365
WHARTON, NJ 07885

NPI-1023125879
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/15/2016
JURGENSON, THEODORE W. (DPM)
438 BROADWAY
LONG BRANCH, NJ 07746

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
Arete Development Inc.Arete Development Inc.
20 Industrial Road
Fairfield, NJ 07004

Justin Ettere, Vice-President
52 Brass Castle Road
Washington, NJ 07882

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/5/2016 01/04/2019
JYAMFI, CHARLES (RPH)
71 OLD SHORT HILLS ROAD
WEST ORANGE, NJ 07052

NPI-
Medical
Contingent Fees
Suspension

Human Services
Medical Assistance (Medicaid)

3/22/2006
KACHMAR, DAVID, PRESIDENT
11 BLUE RIDGE AVENUE
GREEN BROOK, NJ 08812

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/18/2011 11/17/2014
KAHN, MARK
910 CEDAR STREET
MILLVILLE, NJ 08332

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/4/2016 2/3/2019
KAHONU, ANNE N.
315 MILL ST.
S. PLAINFIELD, NJ 07080

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/19/2013
KAJI, VIKRAM (MD)
310 COVE LANE
BEACH HAVEN, NJ 08008

NPI-1346326634
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/10/2019 Permanent
KALFUS, DENIS H. (DPM)
1015 EAST GLEN AVE.
WASHINGTOWN TWP, NJ 07606

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003 DECEASED
KALINOSKI, STEPHEN (RPH)
178 KINGFISHER DRIVE
MIDDLETOWN, NJ 07748

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2018
KALINOWSKI, KAROL (RN)
31 COVINGTON LANE
VOORHEES, NJ 08043

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017 11/18/2019
KALLEN, HERBERT
274 RIVER ROAD
ST JAMES ISLAND, NY 11780

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
KAMARA, HELEN H. (CHHA)
P.O. BOX 509
PALMYRA, NJ 08065

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
KANE, TINA (APN/RN)
157 EVERGREEN AVENUE
VILLAS, NJ 08251

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/9/2019
KANEVSKY, ZHANNA (MD)
28 KEPPEL AVENUE #10307
STATEN ISLAND, NY 10307

NPI-1073551065
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/4/2014 Permanent
KANG, BYUNG (MD)
122 LONG HILL ROAD
LITTLE FALLS, NJ 07424

NPI-1164599213
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/23/2016
KANIA, RAMESHCHAN (MD)
310 CENTRAL AVE SUITE 10
EAST ORANGE, NJ 07018

NPI-1235158403
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012 10/3/2019
KANIA, RAMESHCHAN (MD)
310 CENTRAL AVE STE. 106
EAST ORANGE, NJ 07018

NPI-1235158403
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/20/2014 10/3/2019
KANKAM, MARTIN
13 G READING RD.
EDISON, NJ 07083

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/30/2005
KANZ JR., JOHN T. (RPH)
136 HILLCREST AVENUE
HILLTOP, NJ 07542

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/17/1984 Permanent
KAPLAN, DONALD (DPM)
701 PALMER AVENUE
ALLENHURST, NJ 07711

NPI-1952433567
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/25/2010
KAPLAN, HARMON B. (DDS)
1251 PATERSON PLANK RD.
SECAUCUS, NJ 07094

NPI-1093991044
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/26/1988 Permanent
KARASEK, ROBERT D. (DMD)
64 DOCKSIDE DRIVE
SOMERS POINT, NJ 08244

NPI-1689794042
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2016
KARASEK, ROBERT D. (DMD)
559 PLAINFIELD AVENUE
BERKELEY HEIGHT, NJ 07922

NPI-1689794042
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2014
KARES, FRANCES (RPH)
615 SUMMIT ROAD
UNION, NJ 07083

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/16/1983 2/16/1991
KARFUNKEL, DAVID M.
100 HOWARD AVENUE
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/2/2008 10/25/2013
KARGE, FREDRICK
PO BOX 190
AVENEL, NJ 07001

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/28/2007
KARNER, ANNA (EMT)
17 MAPLE AVENUE
PINE BROOK, NJ 07058

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/23/2002
KARSHENBOYM, ALEXANDER
90 WEST HILL ROAD
WOODCLIFF LAKE, NJ 07677

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/20/2007
KAUFMAN, SHOSHANA AKA STOKELBERG, SHOSHANA (LCSW)
349 JESTER COURT
OLD BRIDGE, NJ 08857

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/15/2009 11/7/2014
KAUL, RICHARD (MD)
292 ATLANTIC STREET
HACKENSACK, NJ 07601

NPI-1902838790
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/1/2014
KAVROS, STEVEN J. (DPM)
12 HERITAGE COURT
CHERRY HILL, NJ 08034

NPI-1316912801
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 8/22/2019
KAWAN JABAKJI, MOHAMED (MD)
160 HALEDON AVENUE
PROSPECT PARK, NJ 07508

NPI-1760541312
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/16/2016
KAWAN JABAKJI, MOHAMED (MD)
6 BARKER PLACE
WAYNE, NJ 07470

NPI-1760541312
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
KAY, KWAME (CHHA)
PO BOX 961186
MIAMI, FL 33296

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
KEE, TERRAYA C. (CHHA)
CLINTON STREET
CAMDEN, NJ 08105

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/30/2007 Permanent
KEELEN, SUSAN (RN)
272 OLD YORK ROAD
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001 1/27/2012
KEENEY, RICHARD (DC)
112 BALTIMORE STREET
HANOVER, PA 17331

NPI-1255461430
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
HFM Labor Ready LLCHFM Labor Ready LLC
459 Rt 38 West
Maple Shade, NJ 08052

Keith Ludwig, Member
459 Rt 38 West
Maple Shade, NJ 08052

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/6/2015 01/05/2018
Keith Mishoe, Owner
341 Seaton Avenue
Roselle Park, NJ 07204

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/21/2013 11/20/2016
KELLER, MIKE
233 LEXINGTON AVENUE
DUMONT, NJ 07628

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/6/2013 3/5/2016
KELLEY, JANINE (RN)
126 S. LECATO AVENUE
AUDOBON, NJ 08106

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/2/2018 Permanent
KELLOGG, WILLIAM T. (MD)
47 MAPLE STREET, STE. 204
SUMMIT, NJ 07901

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/9/1996 2/28/2014
KELLUM, BETZAIDA (CHHA)
1936 S. 8TH STREET, APT. B13
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
KELLUM, EARLENE (CHHA)
279 S. BLACKHORSE PIKE
MOUNT EPHRAIM, NJ 08059

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2018
KELLY, MICHELLE
963 PARK AVENUE
PLAINFIELD, NJ 07060

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/24/2002
KELLY-UPPER, DENISE
2200 ATLANTIS AVENUE
MAYS LANDING, NJ 08330

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
KEMENY, GEORGE (MD)
39 THIRD STREET
ELIZABETH, NJ 07206

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/1977 Permanent
KEMOKAI, JOSEPHINE (LPN)
29 BENNETT AVENUE
RANDOLPH, NJ 07869

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
KENDRICK, SOPHIA (CHHA)
4 OAK WALK
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/17/2018
KENNEALLY, CHRISTOPHER (RN)
1308 NOREEN DRIVE
BURLINGTON, NJ 08016

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2019
Ranco Mechanical, Inc.
2 Melba Drive
Newton, NJ 07860

Kenneth Davis, President
P. O. Box 510
Augusta, NJ 07869

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/29/2013 10/28/2016
Shoreline Marine Construction, LLC
213 West Edgewood Ave
Linwood, NJ 08221

Kenneth Pontari, Partner
213 West Edgewood Avenue
Linwood, NJ 08821

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/4/2013 06/03/2016
KEREKES, KEVIN #65504-050
FCI SCHUYKILL, PO BOX 759
MINERSVILLE, PA 17954

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/1/2019
KESHISHIAN, PAUL (DO)
625 COBH ROAD
RIVER VALE, NJ 07675

NPI-1437207610
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/22/1999 3/15/2000
Division Ten Installations, LLC
29 Monmouth Road
Monroe Twp., NJ 08831

Kevin G. Eib
29 Monmouth Rd
Monroe, NJ 08831

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/3/2014 4/2/2017
KEYES, DONNA (CHHA)
4433 EAST MILLS ROAD
MAPLE SHADE, NJ 08052

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
I & I INVALID COACH, INC.
85 CENTRAL AVENUE
CLIFTON, NJ 07015

KHAIR, IMADELIN A.
160 ALABAMA AVENUE
PATERSON, NJ 07505

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/28/2001
KHAIR, IMADELIN A.
FORT DIX FCI, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/2017
KHAJAVI, ABDOLALI (MD)
HIGHWAY 94 & OSBOW LANE
FRANKLIN, NJ 07416

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/20/1999 Permanent
KHAN, ASIF ALI
909A BROAD STREET
NEWARK, NJ 07102

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/5/1996 Permanent
S. BROTHERS PHARMACY, INC.
687 FRELINGHUYSEN AVENUE
NEWARK, NJ 07114

KHAN, AZAM HYAT
687 FRELINGHUYSEN AVENUE
NEWARK, NJ 07114

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/16/1998
S. BROTHERS PHARMACY, INC.
687 FRELINGHUYSEN AVENUE
NEWARK, NJ 07114

KHAN, AZAM HYAT
687 FRELINGHUTSEN AVENUE
NEWARK, NJ 07114

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/21/1999 Permanent
KHAN, AZAM HYAT
107 CHARLESTON AVENUE
STATEN ISLAND, NY 10309

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/7/2008
KHAN, MUNIR
238 GRAND ST. APT. 1
JERSEY CITY, NJ 07302

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/20/2009 Permanent
KHAN, SALEEM M.
336 2ND ST. APT.1
JERSEY CITY, NJ 07302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2003
KHAN, TAUQIR
P.O. BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2010 Permanent
KHANDWALA, NITIN (RPH)
225 MILLBURN AVENUE
MILLBURN, NJ 07041

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/21/1999 11/29/2012
KHANNA, YASH (MD)
310 CENTRAL AVENUE
EAST ORANGE, NJ 07018

NPI-1093805012
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/30/2014
KHANNA, YASH K. (MD)
825 BLOOMFIELD AVE ST L1
VERONA, NJ 07044

NPI-1093805012
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/2012
KHANTHAN, SUBRAMANIAM (MD)
327 SCHUYLER AVENUE
KEARNY, NJ 07032

NPI-1003882663
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2019
VIP CARE, INC.
49 GATES COURT
MATAWAN, NJ 07747

KHAPCHIK, DMITRY
49 GATES COURT
MATAWAN, NJ 07747

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/10/2019
KHARKOVER, ALEKSANDR (PT)
FCI FORT DIX PO BOX 2000
FORT DIX, NJ 08640

NPI-1861594889
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2013
KHURANA, NORENDRA
32 ROLLING HILLS LANE
HARRISON, NY 10528

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
K&K Construction LLC
685 Bergen Blvd.
Ridgefield, NJ 07657

Ki Kuk Kim, Partner
685 Bergen Blvd
Ridgefield, NJ 07651

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/10/2014 06/09/2017
KIBALLO, MARIAN B. (RN)
4 OJIBWA COURT
WARETOWN, NJ 08758

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/18/2003
KIKTA, DANUTA (RN)
593 GREENWICH COURT
HIGHTSTOWN, NJ 08520

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/25/2019
KILLEN, DAWN (LPN)
804 COTSWOLD ROAD
SOMERDALE, NJ 08083

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2006
KILLMEYER, LINDA (RN)
875 QUAKER CHURCH ROAD
PERRYOPOLIS, PA 15473

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
KIM, DOYOUN (MD)
2302 BAY HEAD DRIVE
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/13/1999 Permanent
KIM, DOYOUN (MD)
545 KEARNY AVENUE
KEARNY, NJ 07032

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/30/1998
KIM, JENNIFER J. (RPH)
1117 INWOOD TERRACE
FORT LEE, NJ 07024

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/23/2003
KIMBLE, SABRINA
341 OSBOURNE TERRACE, 2C
NEWARK, NJ 07106

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2009
KIMMEL, STEVEN (CONTRACTS MANAGER)
420 DELAWARE ST.
MINNEAPOLIS, MN 55455

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/1/2002
KINDER, EDWARD P.
5180 LA TERRA AVE.
PAHRUMP, NV 89061

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2009 7/17/2014
KING, DEBORAH AKA BENTON, DEBORAH (LPN)
9 RADFORD PLACE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/18/2001 11/5/2018
KING, ELAM
6285 PLANK ROAD
NARVON, PA 17555

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/15/2014 9/14/2017
KING, JOHN ANDERSON (DO)
11310 S. ORANGE BLOSSOM
ORLANDO, FL 23837

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2007
KING, WILLIAM (MD)
LEWISBURG USP, PO BOX 1000
LEWISBURG, PA 17837

NPI-1457411670
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2010
KIRWIN, SHANNON (RN)
114 NORTHMONT AVENUE
MOUNT EPHRAIM, NJ 08059

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/18/2007
KISSAM, JEFFREY
1506 RUSTIC DRIVE
OCEAN TOWNSHIP, NJ 07712

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/28/1992 Permanent
KLAUMENZER, JANE (RN)
8 TENNESSEE AVENUE
LONG BEACH TWP., NJ 08008

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2003
KLAUSNER, MARC (RPH)
4515 BERGENLINE AVENUE
UNION CITY, NJ 07087

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/29/1999
KLAUSS, GUNNAR (MD)
30 PROSPECT AVENUE
HACKENSACK, NJ 07601

NPI-1962685305
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/1/2014 6/22/2017
KLEES, DAVID (DO)
1527 LINWOOD AVENUE
ERIE, PA 16510

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KLEINMAN, MARSHA (PSYCH
32 NORTH 7TH AVENUE
HIGHLAND PARK, NJ 08904

NPI-1043332893
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/4/2012
KLEINMAN, MARVIN (AUDIOLOGIST)
1 CLARIDGE DRIVE, APT. 508
VERONA, NJ 07044

NPI-1609995307
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
KLEMONS, IRA (DDS)
23 DEERPATH LANE
COLTS NECK, NJ 07722

NPI-1841393386
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2017
KLEYMAN, VLADIMIR (RPH)
3 CATHEDRAL DRIVE
LAKEWOOD, NJ 08701

NPI-1386957710
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/23/2016
KLEYMAN, VLADIMIR #66307-050 (RPH)
FCI-OTISVILLE, PO BOX 1000
OTISVILLE, NY 10963

NPI-1386957710
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
KMET, BOGDAN
363 EAST ROOSEVELT BOULEVARD
PHILADELPHIA, PA 19120

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KMET, NAZARIY
2284 SANTRAP ROAD
JAMISON, PA 18929

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KMET, ROSTISLAV
13021 BLAKESLEE DRIVE, APT. A
PHILADELPHIA, PA 19116

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KOBYLECKYJ, CRYSTYNA (RN)
35 WOODCOCK MOUNTAIN ROAD
WASHINGTONVILLE, NY 10992

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2017
KOCH, MARK (DO)
336 BARNES ROAD
MONROEVILLE, AL 36460

NPI-1528102647
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KOGAN, VADIM (RN)
56 NORMANDY DRIVE
PRINCETON JUNCT, NJ 08550

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/18/2003
KOHFELDT, LISA (RN)
242 WEST FRONT STREET, APT. 2
FLORENCE, NJ 08518

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/7/2019
KOLLMER, W. LANCE (MD)
101 OLD SHORT HILLS ROAD
WEST ORANGE, NJ 07052

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2001 DECEASED
KONTOS, DEMETRIUS D. (MD)
463 TENAFLY ROAD
ENGLEWOOD , NJ 07631

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2000
KOPLITZ, MARSHALL
256 NORWOOD AVENUE
DEAL, NJ 07723

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/10/1999
KORNAK, PAUL H. (MD)
ELKTON FCI, BOX 10
LISBON, OH 44432

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2007
KOSLOV, GLEB M. (DC)
388 RAMAPO VALLEY ROAD
OAKLAND, NJ 07436

NPI-1366584583
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
KOTHALANKA, SITARAMAKRISHNA (MD)
562 SW ROMORA BAY
PORT LUCIE, FL 34986

NPI-1184644080
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
KOTTURI, SHIVA (MD)
512 KEARNY AVENUE, SUITE B
KEARNY, NJ 07032

NPI-1013168251
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/17/2018 Permanent
KOUSOULIDES, LOUISE (RN)
34 TOPANEMUS LANE, APT. 14
FREEHOLD, NJ 07728

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2009
KOUZMA, NATALIA (CHHA)
122 CHELSEA WAY
BRIDGEWATER, NJ 08807

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
KOVAR, GRACE M. (RN)
929 CHELSEA DRIVE
BRICKTOWN, NJ 08724

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
KOWNACKY, MEGAN (RN)
622 WALDEN WAY
LUMBERTON, NJ 08048

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017
KOZIUPA, HELENE A. (LPN)
64 WESLEYAN DRIVE
TRENTON, NJ 08690

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
KRACKE, BARBARA (LPN)
44 COVINGTON COURT
EAST BRUNSWICK, NJ 08816

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/13/2018
KRAEMER, LINDA (LPN)
436 SAINT ANDREW PLACE
MANALAPAN, NJ 07726

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
KRAKAUER, RANDALL (MD)
900 W MAIN ST
FREEHOLD, NJ 07728

NPI-1588811012
Medical
Poor Performance
Disqualification

Human Services
Medical Assistance (Medicaid)

2/25/1985
KRAMER JR., EDWARD (DC)
106 MOTT ROAD
BLAIRSTOWN, NJ 07825

NPI-1285762401
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/28/2017 Permanent
KRAMER, LARRY S. (RPH)
650 PALISADES AVE
ENGLEWOOD CLIFF, NJ 07632

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/10/2003
KREISMAN, MARCIA
8800 BOULEVARD EAST, APT. 6J
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2004 Permanent
KRESKI, CHRISTINA (RN)
2667 PAXTONVILLE ROAD
MIDDLEBURG, PA 17842

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
KRICHEVSKY, RITA (MD)
4429 DRIFTWOOD DRIVE
PHILADELPHIA, PA 19129

NPI-1851561963
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2017
KRICHEVSKY, RITA (MD)
712 KEEFE ROAD
LAWRENCEVILLE, NJ 8648

NPI-1851561963
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2019
KS Exteriors, LLCKS Exteriors, LLC
650 Ohio Ave
Trenton, NJ 08638

Kris Brezinska, Owner
650 Ohio Ave
Trenton, NJ 08638

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/9/2016 03/08/2019
KRIVOSHIK, MARK (MD)
16 YEGER DRIVE
ALLENTOWN, NJ 08501

NPI-1669409306
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015 10/27/2020
KROHN, IVAN T. (MD)
33 NORTHWOOD DRIVE
VINELAND, NJ 08360

NPI-1467429258
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2012
KROHN, IVAN T. (MD)
33 NORTHLAND DRIVE
VINELAND, NJ 08360

NPI-1467429258
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2011
KROMAH, ANGIE (RN)
3206 LAWNDALE DRIVE EAST
GREENSBORO, SC 27408

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
KROWICKI, JENNIFER B. AKA GRASSER, JENNIFER (RN)
232 CLUB DRIVE
WALL, NJ 07719

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
KRUTYOYARSKY, IRINA #65107-050
ALDERSON FEDERAL PRISON, GLEN RAY ROAD, BOX A
ALDERSON, WV 24910

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/12/2016
Old World Construction, Inc.
19 Woodville Rd
Hopewell, NJ 08525

Krzystof Oprzadek, President
PO Box 35
Pennington, NJ 08534

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2015 02/10/2018
KUBACKI, JOSEPH (MD)
PO BOX 3949
PENSACOLA , FL 32516

NPI-1306834213
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/20/2013
KUBLIN, ANNE (MD)
182 WHALEPOND ROAD
EATONTOWN, NJ 07724

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/19/2004
KUDLA, ALEXANDER
1449 LLOYD TERRACE
MILLVILLE, NJ 08332

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
KUKASH, ABIGAIL
6648 WEXFORD AVENUE
RICHMOND, VA 23255

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
KUKASH, MAJDI AKA MIKE
87-02 PENNSBURY PLACE
RICHMOND, VA 23255

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
KUKREJA, NAV R. (MD)
1331 COVENTRY COURT
ISELIN, NJ 08830

NPI-1295739662
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/15/2016
KULYK, ODARKA (CHHA)
6 COLBY COURT
LINCOLN PARK, NJ 07035

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
KUMAR, ANIL
184 OLD BEEKMAN ROAD
MONMOUTH JUNCT., NJ 08852

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/14/2005 Permanent
KUMAR, SAROJ
184 OLD BEEKMAN ROAD
MONMOUTH JUNCT., NJ 08852

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/14/2005 Permanent
KUNZ, BARBARA (RN)
55 THIRD STREET
NEW YORK, NY 10956

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/21/2018
KURAN, BASSEM
FCI FAIRTON, PO BOX 420
FAIRTON, WV 08320

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/2017
KURBAN, HAKAN
41 SIDNEY AVENUE
RUTHERFORD, NJ 07070

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/22/1999 Permanent
KURIAN, LISSYAMMA (RN)
1253 COLLIDGE AVENUE
UNION, NJ 07083

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
KURIS, JAY (MD)
160 MONTDALE DRIVE
PRINCETON , NJ 08540

NPI-1003997453
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/18/2019
KURLANDER-ZAKARIA, TRACI (RN)
20 ROCK ROYAL ROAD
TRENTON, NJ 08620

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2010
KURTZ, JOEL P. (DMD)
9 WESTGATE ROAD
LIVINGSTON, NJ 07039

NPI-1285874743
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
KUSHMAN, JOSEPH (MD)
224 COLONIAL AVENUE
UNION, NJ 07083

NPI-1205025541
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
KUSHNER, ALAN (DC)
SCI GRATERFORD, JG1165, PO BOX 244
GRATERFORD, PA 19426

NPI-1558398396
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
KUYINU, MICHAEL (MD)
24 VANDERVEER DRIVE
BELLE MEAD, NJ 08502

NPI-1235173568
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
Kwang Hee Kim, Partner

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/10/2014 6/9/2017
KYMER, RHIANNON (ROOSMA) (RN)
8 SPENCER LANE
WARREN, NJ 07059

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2018
LABORDE, JAMES (DC)
329 SOUTH HIGHLAND STREET
DUBOIS, PA 15801

NPI-1578541504
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LABOY, MICHELLE (LPN)
71 LYCEUM COURT
STATEN ISLAND, NY 10310

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017 11/2/2017
LABRUNA, VINCENT A. (DDS)
227 EAST 19TH STREET
NEW YORK, NY 10003

NPI-1801192216
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2002 1/29/2018
LABRUNA, VINCENT A. (DDS)
EAST 19TH STREET
NEW YORK, NY 10003

NPI-1801192216
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002 1/29/2018
JRL HEALTH ASSOC., LTD
479 INNES ROAD
WOODBRIDGE, NJ 07075

LACEY, JOAN R. (RN)
479 INNES ROAD
WOODRIDGE, NJ 07075

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2000
LACRICCHIO, RICHARD C.
150 ROUTE 150
DENVILLE, NJ 07834

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
LAFON, MICHAEL (MD)
107 E. MANTUA AVE.
WENONAH, NJ 08090

NPI-1609168715
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2004 2/16/2015
LAGRADA, WILLIAM (MD)
1300 MAIN STREET, STE2D
CLIFTON, NJ 07011

NPI-1316996762
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/15/2012 9/25/2014
LAGRADA, WILLIAM (MD)
15 FORSYTHIA DRIVE
EDISON, NJ 08837

NPI-1316996762
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/25/2014
LAGUERRE, JEAN EDWARD (RPH)
1 62ND STREET APT 4C
W. NEW YORK, NJ 07093

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/16/2007
LAGUERRE, JEAN EDWARD (RPH)
1 62ND STREET APT 4C
WEST NEW YORK, NJ 07093

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/29/2008
LAI, MYUNG-OK (RN)
40 PONY LANE
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/13/2018 6/27/2019
LAIDO, JOSEPH (CHHA)
722 SIXTH STREET
LYNDHURST, NJ 07071

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
LAJEWSKI, WAYNE (MD)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1558364166
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2015
LALLEMAND JR., ROGER (MD)
4 TYCOR COURT
HOLMDEL, NJ 07733

NPI-1770575821
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2014
LAM, MICHAEL CHUNG KAY (MD)
28TH STREET
ENGLEWOOD CLIFF, NJ 07632

NPI-1184656050
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/14/2014
LAM, MICHAEL CHUNG KAY (MD)
1625 ANDERSON AVE
FORT LEE, NJ 07024

NPI-1184656050
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2014
LAMBRIOLA, VINCENT P. (DDS)
143 LITTLE FALLS
CEDAR GROVE, NJ 07009

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2001 Permanent
LAMP, REBECCA (RN/CNP)
139 DERWOOD DRIVE
NEW CUMBERLAND, WV 26407

NPI-1568511236
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LAMPARELLI, NICHOLAS (RPH)
149 SUMMIT AVENUE
ISLAND HEIGHTS, NJ 08732

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/2003 Permanent
LAMPHIER, JENNIFER (DMD)
38 SILVERSIDE ROAD
LAKEWOOD, NJ 08701

NPI-1487860649
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/23/2019
LAMPROU JR., EMANUEL (MD)
509 N. BROAD ST.
WOODBURY, NJ 08096

NPI-1033104526
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

12/18/2012 12/18/2015
LANCE-LANNIGAN, JUDITH
12 PROSPECT HILL
FLEMINGTON, NJ 08822

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/23/2010 DECEASED
LANDOU, LISSA S. (DC)
17B 16TH AVENUE
EMLMWOOD PARK, NJ 07407

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/2002
LANE, EDWIN (MD)
BEACHWOOD BOULEVARD
BEACHWOOD, NJ 08722

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)


DECEASED
LANG, ANTHONY
151 SOUTH DURAND PLACE
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/19/2009 10/19/2014
LANG, BRIAN E. (LPN)
634 SPROUL STREET
CHESTER, PA 19013

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2006
LANG, DEBRA (CHHA)
124 VAN BUSKIRK ROAD
TEANECK, NJ 07666

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
LANGERAAP, JOHN (DC)
198 WHITE LAKE ROAD
LAFAYETTE, NJ 07848

NPI-1720299092
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/26/2018
LANGERAAP, JOHN (DC)
289 WEST MOUNTAIN ROAD
SPARTA, NJ 07871

NPI-1720299092
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2020
LANGLIEB, MARTIN S. (DDS)
0-94 MIDLAND AVENUE
FAIRLAWN, NJ 07410

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/25/1999 Permanent
LANNON, JENNIFER (RN)
520 COLLINGS AVENNUE
COLLINGSWOOD, NJ 08108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/4/2018
LAPORTE, EDYNE (RN/LPN)
1107 FURTH ROAD
VALLEY STREAM, NY 11581

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/27/2007
LASHKEVICH, JOHN P.
9 CHARLES LANE
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/8/1998
LASTIVKA, MARTA (CHHA)
28 WINDING WOOD, APT. 2-B
SAYREVILLE, NJ 08872

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
LASTRA, ABRAHAM
1808 BERGENLINE AVENUE
UNION CITY, NJ 07087

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2010
LASTRA, ABRAHAM
500 HIGHLAND AVENUE
NEWARK, NJ 07102

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/15/1999 Permanent
LATAWIEC, ANDREA (RN)
1681 RARITAN ROAD
CLARK, NJ 07066

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2002
LATCHMAN, BHANWATIE (PHARM TECH)
76 WATSON AVENUE
EAST ORANGE, NJ 07052

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/16/2016
GST Power Service Group Inc.
2801 Remington St Suite 3
Fort Collins, CO 80526

Lauchland Roberts, President
2801 Remington Street Suite 3
Fort Collins, CO 80525

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/4/2015 05/03/2018
LAURIA, SHANNON (CHHA)
86 FORT DE FRANCE AVENUE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/7/2017
LAURITANO, LAURA (RN)
47 OLD ORCHARD COURT
CEDAR GROVE, NJ 07009

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017 8/2/2019
LAVELLE, BARBARA (RN/APN)
550 LINCOLN AVE.
RIDGEFIELD, NJ 07657

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/18/2003
LAVNEVICH, NAUM (CHHA)
11 HIAWATHA BLVD.
OAKLAND, NJ 07436

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

11/4/2014
LAVNEVICH, NAUM (CHHA)
11 HIAWATHA BLVD.
OAKLAND, NJ 07436

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
LAZOW, SOLOMON M. (MD)
199 MAIN ST
MATAWAN, NJ 07747

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
LEATHERDALE, LAURA (CHHA)
4 MEETINGHOUSE ROAD
WRIGHTSTOWN, NJ 08562

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
LEBAK, STEPHANIE (APN/RN)
92 EATON ROAD
BORDENTOWN, NJ 08505

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/29/2019
SP-One LLc
2816 Coronado Way
Vero Beach, FL 32960

Lee Dinenberg, President
2816 Coronado Way
Vero Beach, FL 32960

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/22/2013 07/21/2016
LEE JR., SAMUEL (RPH)
34 PINAFORE LANE
WILLINGBORO, NJ

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/30/1997 Permanent
LEE, AUGUSTINE (MD)
PO BOX 329002
BROOKLYN, NY 11232

NPI-1255478269
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/29/2013
LEE, AUGUSTINE (MD)
905 STUYVESANT AVENUE
TRENTON, NJ 08618

NPI-1255478269
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

12/22/2011
LEE, BRIAN (LPN)
1722 COPE STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002 8/9/2013
LEE, BRIAN (LPN)
1722 COPE STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2018
LEE, CHANG HO (MD)
535A 7TH STREET
PALISADES PARK, NJ 07650

NPI-1679795181
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
LEE, DAVID (MD)
46 CONSTITUTION DRIVE
SOUTHAMPTON, NJ 08088

NPI-1275633562
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/22/2016 Permanent
LEE, LAURA
7280 LEMINGTON AVENUE
PITTSBURGH, PA 15206

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LEE, STEVE Y. (DDS)
1219 MAIN AVENUE
CLIFTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/19/2001
LEE, SYLVIA S. (MD)
27 SUNSET PLACE
EMERSON, NJ 07630

NPI-1275518490
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/26/2013
LEEDS, GARY (MD)
77 WEST 15TH STREET, APT. 6-H
NEW YORK, NY 10011

NPI-1316005036
Medical
Antitrust/Anti-Kickback Acts
Debarment

Human Services
Medical Assistance (Medicaid)

11/21/2016
LEEDS, GARY (MD)
16 ELIZABETH LANE
RIVERSIDE, CT 06878

NPI-1316005036
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/2017
LEIBER, CHARLES
5804 BOARDWALK, APT. 104
VENTOR, NJ 08406

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/22/2007
LEIBMAN, JOSEPH B. (MD)
PO BOX 1005
PORT JERVIS, NY 12771

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/22/2000 Permanent
LEISER, SHAUL (RN)
14 HICKORY HILL ROAD
JACKSON, NJ 08527

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/7/2018 6/8/2021
TAU Associates Plumbing & Mechanical LLC
91 Graham St
Jersey City, NJ 07307

Lek Tauthong, Owner
91 Graham St
Jersey City, NJ 07307

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/18/2013 12/17/2016
LEKWAUWA, CHIKWUEKE (RN)
1643 PARK STREET
RAHWAY, NJ 07065

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/28/2017 6/4/2019
Lemere, Devin
300 Mamaroneck Ave. #733
White Plains, NY 10605

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 6/29/2018
LEMPERT, SELWYN
240 FOOD CENTER DRIVE
BRONX, NY 10474

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000
Lenec, Michael
300 Mamaroneck Ave. #733
White Plains, NY 10605

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 6/29/2018
LEON, JACK
2991 E.CHESTNUT AV UN H80
VINELAND, NJ 08360

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/22/2000 Permanent
LEON SCD UNLIMITED
1071 E. LANDIS AVENUE
VINELAND, NJ 08360

LEON, JACK
1071 E. LANDIS AVENUE
VINELAND, NJ 08360

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/29/1998
LEONARD, BARRY A. (MD)
15 DARIEN DRIVE
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/13/1996 Permanent
LEONARD, JUDITH (RPH)
70 LAUREL DRIVE
LITTLE SILVER, NJ 07739

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2005
LEONARD, TROY (COUNSELOR)
999 COLONIAL ROAD
FRANKLIN LAKES, NJ 07417

NPI-1851691448
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/2016 Permanent
Roncone Construction, L.L.C.Roncone Construction, L.L.C.
192 Emmet St.
Newark, NJ 07105

Leonardo Marques Roncone, Managing Member
275 Chestnut St Store B #113
Newark, NJ 07714

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/3/2015 02/02/2018
LEPKO, ERVIN (MD)
18 JANE DRIVE
ENGLEWOOD CLIFF, NJ 07632

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2002
LERNER, ELIZABETH
GLEN RAY ROAD, BOX A
ALDERSON, WV 24910

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2008
LERNER, MARVIN H. (MD)
1321 WASHINGTON STREET
HOBOKEN, NJ 07030

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2002 Permanent
LESLIE, GLENN (DO)
FMC-LEXINGTON, PO BOX 14500
LEXINGTON, KY 40512

NPI-1285712950
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/9/2016
LESLIE, GLENN (DO)
10 FRANKLIN TURNPIKE
MAHWAH, NJ 07430

NPI-1285712950
Medical
Antitrust/Anti-Kickback Acts
Suspension

Human Services
Medical Assistance (Medicaid)

4/3/2014 11/20/2015
LESLIE, GLENN (DO)
10 FRANKLIN TURNPIKE
MAHWAH, NJ 07430

NPI-1285712950
Medical
Antitrust/Anti-Kickback Acts
Debarment

Human Services
Medical Assistance (Medicaid)

11/20/2015
LETREN, DENISE (CHHA)
916 MADISON AVENUE
UNION , NJ 07083

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/15/2021
LEVELL, CRYSTAL (LPN)
143 N 12TH STREET
NEWARK, NJ 07107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2001 7/23/2012
LEVIN, HARVEY M. (MD)
510 NORTH KINGS HIGHWAY
CHERRY HILL, NJ 08034

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
LEVINE, EDWARD J. (MD)
7 GREEN HILL ROAD
COLTS NECK, NJ 07722

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/22/1999 7/21/2020
LEVY, EDWARD (DDS)
108-34 67TH AVENUE
FOREST HILLS, NY 11375

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/29/2011
LEVY, RICHARD S. (DPM)
177 MAIN ST. SUITE 235
FORT LEE, NJ 07024

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2001
LEWANDOWSKI, KENNETH (DO)
100 ATLANTIC AVENUE
CAMDEN, NJ 08101

NPI-1114070398
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/28/2014
LEWANDOWSKI, KENNETH (DO)
35 TATUM DRIVE
MIDDLETOWN, NJ 07748

NPI-1114070398
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/30/2016
LEWANDOWSKI, KENNETH (DO)
35 TATUM DRIVE
MIDDLETOWN, NJ 07748

NPI-1114070398
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LEWIN, TASHEIKA (CHHA)
139 B 14TH AVENUE
ELMWOOD PARK, NJ 07407

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017 8/21/2018
LEWIS, ERICA (CHHA)
1098 PENNSYLVANIA AVENUE
FRANKLINVILLE, NJ 08322

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018
LEWIS, TOLIA (CHHA)
391 ISABELLA AVENUE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2017
LEYBA, ROGELIO
24 WEBSTER STREET
NEWARK, NJ 07104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
LEYSON, JOSE (MD)
6 RANNEY ROAD
LONG VALLEY, NJ 07853

NPI-1528169539
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/2018 Permanent
LEYSON, JOSE (MD)
6 RANNEY ROAD
LONG VALLEY, NJ 07853

NPI-1528169539
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
LI, STAN (MD)
16 SECRETARIO WAY
HAMILTON, NJ 08690

NPI-1386631794
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2015 Permanent
LI, STAN (MD)
16 SECRETARIO WAY
HAMILTON, NJ 08690

NPI-1386631794
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015 Permanent
LIBERTOFF, STUART
4901 GLENWOOD ROAD
BROOKLYN, NY 11234

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000
LIBRIZZI, MICHELLE H. (LPN)
5 BELLIS CT.
RINGOES, NJ 08551

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
LICKFIELD, KEVIN J. (DO)
524 JUSTICE DRIVE
MARLTON, NJ 08053

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2003
LIEBOWITZ, LEONARD J. (MD)
5 POE COURT
MORGANVILLE, NJ 07741

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/18/2001 Permanent
LILLO, CHRISTOPHER T. (DMD)
191 HIGHWAY 37 WEST
TOMS RIVER, NJ 08755

NPI-1720150675
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2012
LIMIDO, GLEN CARL (RPH)
1 EAST PLEASANT AVENUE
MAYWOOD, NJ 07607

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
LIMONGELLI, WILLIAM (DDS)
679 SO ORANGE AVE
NEWARK, NJ 07106

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/30/1986 Permanent
LINDER, NORBERT (MD)
4711 BERGENLINE AVENUE
UNION CITY, NJ 07087

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/23/1977 Permanent
LINK, TIMOTHY (MD)
63 MONMOUTH PARKWAY
MONMOUTH BEACH, NJ 07750

NPI-1477767705
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2018
LIPMAN, CLIFFORD R. (MD)
26 UNION AVENUE
FREEHOLD, NJ 07728

NPI-1083676670
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/16/2015 5/30/2018
LIPPIELLO, JENNIE A. (DC)
2920 RT. 23 SOUTH
NEWFOUNDLAND, NJ 07435

NPI-1366605966
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/19/2001
LIPSON, PHILIP A. (DO)
38 W. NORTON DRIVE
SOUTHHAMPTON, PA 18966

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/19/2005
LIRIANO, ANGELA (CHHA)
79 CLINTON AVENUE, APT. #2
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/2017 Permanent
LIRIANO, ANGELA (CHHA)
79 CLINTON AVENUE, APT. #2
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
LIRIANO, ANGELA (CHHA)
79 CLINTON AVENUE, APT. #2
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/19/2018
LIVSHITS, BORIS
1935 83RD STREET, APT E6
BROOKLYN, NY 11214

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/1/2009
LIZIK, MICHELLE (LPN)
451 FULLERTON AVENUE
CAMBRIDGE SPRINGS, PA 16403

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LLANOS, LATOYA (CHHA)
433 W. QUINCE STREET
VINELAND, NJ 08360

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/29/2002
LOAIZA, ERIKA (CHHA)
206 COVENTRY LANE
SOMERSET, NJ 08873

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
LOBO, ANGEL R. (MD)
661 14TH AVENUE
PATERSON, NJ 07504

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/11/2002
LOBO, ANGEL R. (MD)
398 STEWART AVENUE
GARDEN CITY, NY 11530

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2007
LOBO, MERCY
22 HELEN PLACE
CLIFTON, NJ 07011

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/23/2007
LOCK, ABRAHAM J. (MD)
1801 AVENUE J
BROOKLYN, NY 12230

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/25/2001 Permanent
LOCURATOLO, LUIS R. (MD)
104-01 ROOSEVELT AVENUE
CORONA, NY 11368

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/1/1995 Permanent
LOGAN, JEANETTE E. (RN)
12 ARAGON COURT
TRENTON, NJ 08628

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
LOLL-VAN SICKLE, PATRICIA (RN)
416 SALEM STREET
ELMER, NJ 08318

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2000
LOMBARDI, ALAN
26 WHISPERING WAY
BERKLEY HEIGHTS, NJ 07922

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/9/2014 10/8/2017
LOPEZ, JOHN J.
428 N 16TH STREET
KENILWORTH, NJ 07033

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/11/2001
FAMILY DIAGNOSTIC CENTER
293 MONROE STREET
PASSAIC, NJ 07055

LOPEZ, JOSE A. (MD)
24 WOODLAND ROAD
BLOOMFIELD, NJ 07003

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
LOPEZ, JULIANA (CHHA)
236 GRAND AVENUE
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
LOPEZ-FALCONE, JUAN ANTONIO
8385 SW 43RD STREET
MIAMI, FL 33155

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2003
LOPRESTI, JACQUELINE A. (DO)
FPC ALDERSON
ALDERSON, WV 24910

NPI-1043348220
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/20/2014
LOPRESTI, JACQUELINE A. (DO)
568 RIDGE ROAD
FAIR HAVEN, NJ 07704

NPI-1043348220
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2011
LOTTERMAN, RANDEE (RN)
6 JUNIATA STREET
WEST MILFORD, NJ 07480

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2017
LOUIS-BAPTISTE, GUERLINE (CHHA)
51 LINCOLN STREET
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2017
LOUISSAINT, PARACLET (MD)
669 ELIZABETH AVENUE
NEWARK, NJ 07112

NPI-1164519179
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/1/2001 1/11/2017
LOUKHNATI, RAJAA (CHHA)
5 COLGATE DRIVE
CHERRY HILL, NJ 08034

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2017
LOVETT, BETTIE (CHHA)
212 SENACA TRAIL
BROWNS MILLS, NJ 08064

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/28/2013
LOWREY, RODNEY
88 3RD AVE
ATLANTIC HIGH, NJ 07716

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
LUCA, BONNIE J.
1016 WASHINGTON GARDEN AP
WASHINGTON, NJ 07882

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

6/10/2007 Permanent
LUCA, NICOLE
12 RED FOX RUN
MANALAPAN, NJ 07726

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/18/2015 3/17/2018
LUCAS, KATINA (RN)
126 LAGUARDIA AVENUE
STATEN ISLAND, NY 10314

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
LUCAS, MARK OWNER
31 GLASSBORO ROAD
MONROEVILLE, NJ 08343

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/12/2012 10/11/2015
LUDDEN, JAMES W. (DPM)
23 SOCIETY HILL WAY
TINTON FALLS, NJ 07724

NPI-1720054935
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/2016
LUDDEN, JAMES W. (DPM)
23 SOCIETY HILL WAY
TINTON FALLS, NJ 07724

NPI-1720054935
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/8/2007
LUDWICK, DONNA (RN)
7 DEER VALLEY LANE, UNIT 12
VERNON, NJ 07462

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/22/2019
MAIN PHARMACY, LLC.
80 SOUTH MAIN ROAD, SUITE 112
VINELAND, NJ 08360

LUDWIKOWSKI, MICHAEL (RPH)
113 DIXONTOWN ROAD
MEDFORD, NJ 08055

NPI-1861705873

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/13/2018
OLD MEDFORD PHARMACY
639 STOKES ROAD, SUITE 101
MEDFORD, NJ 08055

LUDWIKOWSKI, MICHAEL (RPH)
113 DIXONTOWN ROAD
MEDFORD, NJ 08055

NPI-1619148632

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/13/2018


,

LUDWIKOWSKI, MICHAEL (RPH)
FCI LORETTO, PO BOX 1000
CRESSON, PA 16630

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/14/2021
Caslo Drywall Corp.
644 East 2nd St Unit 2
Plainfield, NJ 07060

Luis Oliveras, Owner
644 East 2nd St Unit 2
Plainfield, NJ 07060

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/23/2014 04/22/2017
Resco, LLCHallmark Electric, LLC
13 Poppy Ave.
Neptune, NJ 07753

Luis Riano, President
13 Poppy Ave
Neptune, NJ 07753

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/26/2015 02/25/2018
L and Y Roofing, LLC
291 Jefferson St
Paterson, NJ 07522

Luis Vargas, Owner
183 Belmont Ave
Haledon, NJ 07522

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/17/2014 03/16/2017
LUNDY, HOWARD
1 MALKE DRIVE
OCEAN, NJ 07712

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/4/2015
LYNCH, CHRISTOPHER (MD)
1719 PENN CROSSING
ALLENTOWN, PA 18104

NPI-1407813975
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
LYNCH, KATHRYN (LPN)
33 STEVEN TERRACE
SOUTH PLAINFIELD, NJ 07080

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/7/2019
LYONS, DANA (LPN)
245 4TH AVENUE
ROEBLING, NJ 08554

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
LYONS-VALENTI, ASHLEY (APN/RN)
119 PALMER PLACE
SWEDESBORO, NJ 08085

NPI-1275715179
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/4/2020 Permanent
LYVAN, KIM (DDS)
199 CANAL STREET #201
NEW YORK, NY 10013

NPI-1346458965
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/27/2000
MAAT, THOMAS P. (LPN)
2311 4TH AVE.
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/18/2004
MACH, PHILIP C. (MD)
PO BOX 1000
LORETTO, PA 15940

NPI-1770562993
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/9/2008
MACH, PHILIP C. (MD)
30 DANIEL DRIVE
FRANKLIN PARK, NJ 08823

NPI-1770562993
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/7/2008
MACH, PHILIP C. (MD)
17 SHELDON ROAD
PEMBERTON, NJ 08068

NPI-1770562993
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/30/2018 Permanent
MACIAS, ERICK (DC)
111 E. DEWEY AVENUE, APT. 254
WHARTON, NJ 07885

NPI-1215311329
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/24/2020
Madara, John H.
319 Terrace Street
Rahway, NJ 07065

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/8/2015 5/7/2018
MADDOX, CALISA (CHHA)
42 TRITON TERRACE
NEWARK, NJ 07104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2019
MADDOX, PEARL V. (CHHA)
KINSLEY ROAD
PEMBERTON, NJ 08068

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/25/2007
MADUR, MATUS, MANAGING MEMBER
75 HART STREET
SAYREVILLE, NJ 08872

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/26/2012 3/25/2015
Magda Zamprogno, Other

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/17/2013 10/16/2016
MAHAJAN, SHYAM S. (MD)
7624-A BRISLIN RD #7
STROUDSBURG, PA 18360

NPI-1144496449
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
MAHARAJ, GANGARAM (RPH)
72 VAN REIPEN AVENUE
JERSEY CITY, NJ 07306

NPI-1326323106
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017
MAHER, PATRICIA (RN)
26 PROSPECT STREET
RAMSEY, NJ 07446

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/7/2019
LA INVALID COACH
1995 JFK BLVD. NO. 14
JERSEY CITY, NJ 07305

MAHGOUB, ADAM
1995 JFK BLVD. NO. 14
JERSEY CITY, NJ 07305

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/17/2002
MAHMOOD, SHAHID
228 GRAND STREET
JERSEY CITY, NJ 07302

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/30/2010
MAHMUD, ASIF (MD)
2024 W. 13TH ST.
BROOKLYN, NY 11223

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/18/2004
MAIGUE, LLEWELYN (RN)
6 CRYSTAL AVENUE
W. ORANGE, NJ 07052

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/19/2001
MAIORANO, JOHN (RPH)
123 EAST END AVENUE
ISLAND HEIGHTS, NJ 08732

NPI-1659492940
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/2002
MAIO'S MEDICINE CHEST
345 UNION HILL ROAD
ENGLISHTOWN, NJ 07726

MAIORANO, JOHN (RPH)
345 UNION HILL ROAD
ENGLISHTOWN, NJ 07726

NPI-1659492940

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/11/2000 Permanent
MAIS, JENNIFER C. (PA)
22 NEW STREET
HILLSDALE, NJ 07642

NPI-1801035084
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/2015
MAJURI, WILLIAM
14 OAK AVENUE
BERLIN, NJ 08009

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001
MAKKER, RAM S. (MD)
52 SNAPDRAGON LANE
ROSLYN HEIGHTS, NY 11577

NPI-1538117213
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2010
MALADY, SUSAN AKA MAWHINNEY-BRIGNOLA, SUSAN (RN)
PO BOX 468
BLAIRSTOWN, NJ 07825

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
ORIENT EXPRESS
177 SARGEANT AVE.
CLIFTON, NJ 07013

MALAMUD, YAFIM
177 SARGEANT AVE.
CLIFTON , NJ 07013

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/8/2003
MALDONADO, CHEYENNE (PHARM TECH)
3 DUKE DRIVE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/5/2017
MALDONADO, SANDRA (CHHA)
2808 CONGRESS ROAD
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
MALDONADO, TOSHIRA (CHHA)
4648 THELMA AVENUE
MAYS LANDING, NJ 08330

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/20/2017
MALIK, ATIF #62539-037 (MD)
FCI LORETTO, PO BOX 1000
LORETTO, PA 15940

NPI-1386-63-1869
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/1/2019
MALIK, MOHAMMAD S.
146 OLD COURT HOUSE RD.
MANHASSETT, NY 11040

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
MALIK, MOHAMMAD S.
146 OLD COURTHOUSE ROAD
MANHASSETT, NY 11400

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

9/22/2000
MALLOY, TIFFANY (APN/RN)
34 VUBURNUM COURT
LAWRENCEVILLE, NJ 08648

NPI-1790910503
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/28/2017
MALLOZZI, DEBORAH (RN)
1603 PERSHING AVENUE
FORKED RIVER, NJ 08731

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
MALONE, THOMAS F.
16192 COASTAL HIGHWAY
LEWES, DE 19958

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/14/2013 5/13/2016
Malpere, Michael
8 Mansion Terrace
Cranford, NJ 07016

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/9/2015 6/8/2018
MANALO, JERICHO (RN)
22 PINE STREET
BLOOMFIELD, NJ 07109

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/13/2017
MANCILLA, MARIA (CHHA)
284 REDMOND STREET
NEW BRUNSWICK, NJ 08873

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/2007
MANCINI PHARMACY INC
SKEET & DIXONTOWN ROAD
MEDFORD, NJ 08055

MANCINI, ANGELO D. (RPH)
SKEET & DIXONTOWN ROAD
MEDFORD, NJ 08055

NPI-

Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

7/1/1985 Permanent
MANDERSCHEID, DAVID L.
310 NORTH HIGH STREET
WEST CHESTER, PA 19380

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/18/2011 11/17/2014
MANFORD, ROSE AKA ACQUAH, ROSE (CHHA)
5507 WARNER VIEW LANE
WESTVILLE, OH 43081

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/13/2018
MANFRE, MARIA (LPN)
262 N. MIDDLESEX COURT
THOROFARE, NJ 08086

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
MANGIONE, MICHELE (RN)
35 LONGVIEW DRIVE
WALDWICK, NJ 07363

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2004 Permanent
MANIN, LAWRENCE
611 BURLINGTON
MT HOLLY, NJ 08060

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/12/1993 Permanent
MANION, WILLIAM (MD)
33 MEADOW ROAD
WOODSTOWN, NJ 08098

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/8/2018
MANJO, EUNICE AKA GUANMESIA, EUNICE (RN)
128 FIELDBROOK DRIVE
MAGNOLIA, DE 19962

NPI-1811443815
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
MANKOFF, BERNARD
GREEN GROVE ROAD
NEPTUNE, NJ 07753

NPI-
Professional
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
MANNAVA, VENKATA SRINIVAS (RPH)
3300 EAST WEST HIGHWAY, APT 206
HYATTSVILLE, MD 20782

NPI-1356478895
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/2016
MANNING, LUTHER
586 WEST SCOTT AVENUE
RAHWAY, NJ 07065

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2008
MANNO, MICHAEL (DC)
PO BOX 1000 CAMP
FORT DIX, NJ 08640

NPI-1356704738
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2003
MANSOUR, ALI (MD)
225 DEMOTT LANE
SOMERSET, NJ 08873

NPI-1346225885
Medical
Antitrust/Anti-Kickback Acts
Debarment

Human Services
Medical Assistance (Medicaid)

12/20/2014 10/25/2019
PER Construction LLC
194 Monmouth Ave
Keyport, NJ 07735

Manuel Pereira, Owner
67 State Route 36 Suite #4
West Long Branch, NJ 07764

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/17/2014 10/16/2017
M.E. Group, LLC
164 Polk Street - Apt 1
Newark, NJ 07105

Manuel Quito, Member
164 Polk Street - Apt 1
Newark , NJ 07105

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 06/29/2018
MANZE, PATRICK (MD)
53 GARDNER AVENUE
CHATHAM, NJ 07928

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2005 DECEASED
MANZELLA, JOHN (DO)
680 BROADWAY AVENUE
PATERSON, NJ 07514

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

6/28/2014
MANZI, JOHN J. (RPH)
6 TEMPLE ROAD APT 22 C
VINELAND, NJ 08360

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MANZONI, JANET M. (DC)
52 TENNET ROAD
MORGANVILLE, NJ 07751

NPI-1851497168
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/3/1998
MANZONI, JANET M. (DC)
9 KILMER DRIVE
MANALAPAN, NJ 07726

NPI-1851497168
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2009
MARC, DAMILOLA (LPN)
165 FULTON AVENUE, APT. 3
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2019
MARCELL, JOSEPH A.
305 MAIN ST
RIDGEFIELD PARK, NJ 07660

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
MARCHAND, ANTHONY (MD)
19 DEXTER DRIVE NORTH
BASKING RIDGE, NJ 07920

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
MARCHETTA, LEONARD (PA)
FCI-FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1720196140
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
MARCOS, FRANCISCO (RPH)
777 CHARNWOOD DRIVE
WYCKOFF, NJ 07481

NPI-1699158063
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2011 4/5/2017
MARCUS, ALAN L. (DC)
789 CLIFTON AVENUE
CLIFTON, NJ 07013

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/25/2001 Permanent
Metropolitan Stone & Tile, LLC
30 Monsisnor Deluca Plaza
Nutley, NJ 07110

Margaret Farina, Owner
102 Richards Ave
Dover, NJ 07801

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/24/2015 09/23/2018
CPS Mechanical Contractors, Inc.
203 Woods Ave
Bergenfield, NJ 07621

Margaret Sherman, President
203 Woods Avenue
Bergenfield, NJ 07621

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/16/2014 12/15/2017
Perfection Erectors, LLCPerfection Erectors, LLC
349 W. Prospect Avenue
Keyport, NJ 07735

Marianne Cammarata, Manager
349 West Prospect Ave
Keyport, NJ 07735

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/24/2016 02/23/2019
Everest Masonry Constructors, Inc.
523 Hamilton Ave
Kingston, PA 18704

Mark Rodrigues, President
1 Orinet Way Suite 226
Rutherford, NJ 07070

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/9/2015 11/08/2018
MARKOFF, MORTON (DO)
908 FRANCINE DRIVE
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/7/1997 DECEASED
MARKOSOVA, GRETA (CHHA)
2301 WESTMINSTER BOULEVARD
PARLIN, NJ 08859

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
MARKOWSKI, TOMASZ
2026 HIMROD ROAD
RIDGEWOOD, NY 11385

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/19/2012 4/18/2015
MARON, ANDREW (DDS)
326 BROAD STREET
RED BANK, NJ 07701

NPI-1215035134
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/21/2015
MARON, ANDREW (DDS)
326 BROAD STREET
RED BANK, NJ 07701

NPI-1215035134
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/1/2019
MARONPOT, BARBARA (DDS)
281 MENDHAM ROAD
BERNARDSVILLE, NJ 07924

NPI-1821203696
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/17/2015
MARQUEZ, MANUEL S. (MD)
112 DOWNING COURT
MT. LAUREL, NJ 08054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/5/1997 DECEASED
MARQUEZ, OLGA (COUNSELOR)
2827 LINCOLN AVENUE
CAMDEN, NJ 08105

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2003
MARRAZZO-TALLIA, CHRISTAL (RPH)
406 HARDING ROAD
FAIRHAVEN, NJ 07704

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
MARSHALL, HAROLD
1800 EVA STREET
AUSTIN, TX 78704

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/11/2014 5/10/2017
MARSON-FRANCIS, JAVON (CHHA)
7810 CORBETT ROAD
PENNSAUKEN, NJ 08109

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2017
MARTIN, ANDRE (COUNSELOR)
127 N. DERBY AVENUE
VENTNOR, NJ 08406

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/24/1999 Permanent
MARTIN, BENNIE M. (COUNSELOR)
476 CLIFTON AVENUE
CLIFTON, NJ 07011

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/15/2003
MARTIN, ELLIOTT (DPM)
5 HOLLIS ROAD
E. BRUNSWICK, NJ 08816

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/22/1991 DECEASED
MARTIN, MARGARET (LPN)
207 HEGGEN AVENUE
EGG HARBOR TOWNSHIP, NJ 08234

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/8/2017 Permanent
MARTIN, PATRICK
51 HENRY STREET
SUCCASUNNA, NJ 07876

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MARTIN, SUSAN C. (RN/LPN)
3421 BRIGHTON STREET
PHILADELPHIA, PA 19149

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2005
MARTINEZ, CINTYA (CHHA)
61 CONCORD STREET, APT. 3A
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
MARTINEZ, ELIEZER (COUNSELOR)
215 SOUTH BURLINGTON ROAD
BRIDGETON, NJ 08302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2006
MARTINEZ, NATASHA (CHHA)
87 N. 7TH STREET, APT. 1
PATERSON, NJ 07522

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/26/2018
MARTINEZ, RENATO F. (MD)
199 BROAD ST., SUITE 1-A
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/5/1997
MARTINIQUE, BURTON (OD)
2 SHEFFIELD DRIVE
WILLINGBORO, NJ 08046

NPI-1942370945
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/18/2016
MARTINIZEZ, SUZETTE (CHHA)
52 FOREST GLEN DRIVE
HIGHLAND PARK, NJ 08904

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/31/2017
MARTINS, ANTONIO
215 PRINCETON ROAD
PARLIN, NJ 08859

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
MARTINS, MANUEL
15 CENTER STREET
SOUTH RIVER, NJ 08882

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
MARTINS, ROGERIO
46 GROVE STREET
SOUTH RIVER, NJ 08882

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
MARTIROSOV, ALEKSANDR (DO)
1084 BRIAR WAY
FORT LEE, NJ 07024

NPI-1700931185
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2017 5/30/2018
MARTORANO, JOSEPH (RPH)
1248 STANWOOD STREET
PHILADELPHIA, PA 19100

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MARUCCI, DONATO (MD)
14 FRANKLIN STREET
BELLEVILLE, NJ 07109

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/28/1999 Permanent
MARURI, NAGESWARA REDDY (RPH)
8 REDWOOD AVENUE
WEST ORANGE, NJ 07052

NPI-1083932495
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/1/2016
Marvin Ardon Painting
52 S. Jefferson St.
Orange, NJ 07070

Marvin Alexander Ardon, Owner
52 S Jefferson St
Orange, NJ 07050

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/4/2013 12/03/2016
MASCOLO, JOSEPHINE (RN)
1814 KENNEDY BLVD.
UNION CITY, NJ 07087

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/7/2004
MASHALI, FATHALLA #86065-038 (MD)
FMC DEVENS, PO BOX 879
AYER, MA 01432

NPI-1386609907
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2018
MASI, JAMES (COUNSELOR)
631 OCEAN AVENUE, APT.304
BRADLEY BEACH, NJ 07720

NPI-1518046226
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2013
MASON, JAMES I.
702 SUNSHINE LAKES DRIVE
VOORHEES, NJ 08043

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/23/2000
MASON, SYDELLE
702 SUNSHINE LAKES DRIVE
VOORHEES, NJ 08043

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/23/2000
MASOOD, MARUK
1 CHESTERFIELD DRIVE
WARREN, NJ 07059

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2012
MASOOD, YOUSUF (MD)
PO BOX 8000
BRADFORD, PA 16701

NPI-1235343138
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2012
MASRI, NASSER M.
360 GETTY AVENUE
PATERSON, NJ 07503

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2000 2/15/2019
MASSARO, DONNA M. (THERAPIST)
205 RIVA DRIVE APT 24
HACKETTSTOWN, NJ 07840

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2008
MASTRANGELO, MARTHA (LPN)
12 NORTH 28TH AVENUE
LONGPORT, NJ 08403

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MASTRIA, ERNEST (PSYCH)
213 9TH AVE
BELMAR, NJ 07719

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/18/2011
MASTROKOSTAS, ANTHANASIOS (RPH)
11 EQUINOX LANE
FREEHOLD, NJ 07728

NPI-1861769481
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/15/2009 2/15/2019
MATALON, VIVIENNE (MD)
1 NORTH SYRACUSE DRIVE
CHERRY HILL, NJ 08034

NPI-1396858635
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/2016
MATALON, VIVIENNE (MD)
1 NORTH SYRACUSE DRIVE
CHERRY HILL, NJ 08034

NPI-1396858635
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/31/2016
MATHEW, REX (MD)
131 WEST PARKWAY
POMPTON PLAINS, NJ 07444

NPI-1336164862
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/2/2017
MATHEW, REX (MD)
17608 PRINCE EDWARD DRIVE
OLNEY, MD 20832

NPI-1336164862
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/4/2018
MATRISS, JOSEPH P. (DDS)
337 HENRY STREET
HASBROUCK HEIGHTS, NJ 07604

NPI-1700013554
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/9/2007
MATRISS, JOSEPH, P. (DDS)
337 HENRY STREET
HASBROUCK HEIGHTS, NJ 07604

NPI-1700013554
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

9/18/2003
MATTERN, JILL (MD)
20 WILSON TERRACE, APT 1
STATEN ISLAND, NY 10304

NPI-1669514253
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/29/2015
Matthew Ettere, Vice-President
8 Brookside Drive
Warren, NJ 07059

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/5/2016 1/4/2019
MATTHEWS, BHA'SHEER (CHHA)
16 HEMLOCK WALK
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2017
MATURA, DENISE (RN)
1001 LINDEN AVENUE
BRICK, NJ 08723

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/26/1999 7/20/2012
MATURA, WILLIAM (DC)
PO BOX 7000
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006
MATZ, RODNEY S. (MD)
43 MACDONALD DRIVE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/1995 Permanent
MAUGLE, BARBARA (DPM)
800 HILLSIDE AVENUE
WESTFIELD, NJ 08901

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/10/2001 Permanent
MAUIRI, SANDY (LPN)
34 FRANKLIN PL.
TOTOWA, NJ 07512

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
Advantage Sport USA, Inc.
1 Tigan Street
Winooski, VT 05404

Maurice Guarigilia, Owner / Officer
494 North Barbor Road
Colchester, VT 05446

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/20/2016 01/19/2019
Interstate Home Service Inc.Interstate Home Service Inc.
105 Heights Ave
Fair Lawn, NJ 07410

Maurice Rolando, Owner
165 Heights Ave
Fair Lawn, NJ 07410

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/17/2015 08/16/2018
MAWHINNEY-BRIGNOLA, SUSAN AKA MALADY, SUSAN (RN)
PO BOX 468
BLAIRSTOWN, NJ 07825

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
MAXVITAT, KATHLEEN E. (PHARM TECH)
200 W. MERCHANTS STREET
AUDUBON, NJ 08106

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2011
INDEPENDENCE MEDICAL TRANS.
3 PARKWOOD DRIVE
SOUTH AMBOY, NJ 08879

MAXYMIV, NICOLAI
3 PARKWOOD DRIVE
SOUTH AMBOY, NJ 08879

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2003
MAYER, BARRY
PO BOX 239
AVERNE, NY 11692

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000
MAYER, FREDRICK G. (DC)
610 WOODLAND AVENUE
AVON BY THE SEA, NJ 07717

NPI-1811082894
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2000 9/21/2011
MAYS, CYNTRICE (CHHA)
98 OAK STREET
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2017
MAYS, ROBERT E.
6133 HANLON STREET
CAPITAL HEIGHTS, MD 20743

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/31/2017
MAZUR, BONNIE (DMD)
210 E. SEAVIEW AVENUE
LINWOO, NJ 08221

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/27/1998
MCAFEE, JORDAN (CHHA)
13 FAIRWAY COURT
MARLTON, NJ 08053

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
MCAULAY-LEVESQUE, BARBARA (LPN)
141 BRUNSWICK AVENUE
BLOOMSBURY, NJ 08804

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/27/2019 Permanent
MCCABE, LAUREN AKA BARSH, LAUREN (RN)
9 FIELDCREST WAY
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/30/2019
MCCABE, VALERIE A. (LPN)
830 CHESTNUT STREET
KEARNY, NJ 07032

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2004 Permanent
MCCAFFERTY, ASHLEY (RN)
245 ATLANTIC AVENUE, APT. 115
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2019
MCCAGG, CAROLINE (MD)
1415 MARTINE AVENUE
PLAINFIELD, NJ 07060

NPI-1346261849
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/18/2019 Permanent
MCCALL, ELDORA (CHHA)
OLD CRANBURY ROAD
CRANBURY, NJ 08512

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2007
MCCANN, DAVID
16 LAFAYETTE PLACE
LYNDHURST, NJ 07071

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
MCCARVILLE, MICHAEL (MD)
1020 IRVING AVENUE
ENDICOTT, NY 13760

NPI-1871666321
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MCCASKILL, CAMMY
6518 BOBOLINK PLACE
PHILADELPHIA, PA 19142

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MCCASKILL, JACQUELINE (CHHA)
34 36 12TH AVENUE
PATERSON, NJ 07524

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/15/2004
MCCOLGAN, PETER (DMD)
RR 1, PO BOX 29
TANNERSVILLE, PA 18372

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2001
MCCOLGAN, PETER (DMD)
35 OLD WOLFE ROAD
BUDD LAKE, NJ 07828

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/13/1999 Permanent
MCCREA, NIOME (CHHA)
63 VILLAGE DRIVE
BARNEGAT, NJ 08005

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/26/2017
MCDANIELS, HOLLY (RN)
111 COUNTRYSIDE DRIVE
MYRTLE BEACH, SC 29579

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
MCDONALD, JOSEPH (MD)
2052 MORRIS AVENUE
UNION, NJ 07083

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/21/1999 Permanent
MCDONALD, KEITH (THERAPIST)
2220 MEADOW LANE, APT.D26
SECAUCUS, NJ 07094

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2001 Permanent
MCDONALD, RHONDA (RN)
962 GROVE STREET
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/18/2007
MCDONALD-HASWELL, EVERSLEY
52 ELM STREET
MONTCLAIR, NJ 07042

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/2002
MCDOWELL, SHASHAWN (CHHA)
25 WILLIAM STREET, 2ND FLOOR
LITTLE FALLS, NJ 07424

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/6/2017
MCELROY, DONALD J. (DDS)
14 RESEVOIR AVENUE
DOVER, NJ 07801

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/1983 Permanent
MCFADDEN, SCOTT
3 VICTORY LANE
BRICK, NJ 08723

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
1020

1/6/2016 1/6/2021
MCFADDEN, TIKEYA (CHHA)
526 RAND STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
MCGAVIN, CAMERON LINDSAY (PSYCH)
417 BOYD STREET
TURTLE CREEK, PA 15145

NPI-1760408041
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/27/2015
MCGEE, ELIZABETH (RN)
51 VAN DUYNE AVE
WAYNE, NJ 07470

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
MCGEE, GEORGE, PRESIDENT
99 HILLSIDE TERRACE
PARSIPPANY, NJ 07054

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/7/2013 2/6/2016
MCGEE, JOHN (MD)
1160 KENNEDY BOULEVARD
BAYONNE, NJ 07002

NPI-1811991284
Medical
Wage & Hour Violation
Debarment

Human Services
Medical Assistance (Medicaid)

9/6/2016
MCGILL, WINSTON (MD)
258 CENTRAL AVENUE
ORANGE, NJ 07050

NPI-1093810749
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/16/2014
MCGINNIS, GEORGE J.
119 ADELINE ST
TRENTON, NJ 08611

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/16/1986 Permanent
MCGINTY, JAMIE (RN)
251 DEVON ROAD
TWP. OF WASHINGTON, NJ 07676

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017
MCGLONE, CARL (RN)
10 MILLS BROOK LANE
SHAMONG, NJ 08088

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/2019
MCGLOSTER, CARL L. (DDS)
90 TIFFANY BOULEVARD
NEWARK, NJ 07104

NPI-1962517839
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2007
MCGRATH, HELEN J. (RN)
6 BLAIR RD.
KEDALL PARK, NJ 08824

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2005
MCGRATH, ROBERT (DO)
3411 KENWOOD COURT
MAYS LANDING, NJ 08330

NPI-1912110636
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/13/2020 Permanent
MCGRATH, ROBERT (DC)
FORT DIX FCI, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1417989864
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2018
MCGRATH, ROBERT (DO) #70889-050
CANAAN USP, PO BOX 300
WAYMART, PA 17837

NPI-1912110636
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/5/2019
MCINTYRE, JOHN G. (DDS)
1301 PENN AVENUE
WYOMISSING, PA 19610

NPI-1487740718
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/22/2002 12/2/2011
MCKEAN JR., JOSEPH (MD)
2601 MEADOW VIEW ROAD
EDMOND, OK 73013

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/15/2000 Permanent
MCKEITHAN, SHAVONNE (LPN)
259 SECOND STREET
HACKENSACK, NJ 07601

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
MCKNIGHT, BOBBY
4543 NORTH GRATZ STREET
PHILADELPHIA, PA 19140

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MCLAUGHLIN, KELLY M. (LPN)
SANDYBROOK ROAD
MANALAPAN, NJ 07726

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2008
MCLAY, WILLIAM (MD)
1150 GEORGIA AVENUE
CAPE MAY CH, NJ 08210

NPI-1033133970/1659585438
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2018 Permanent
MCLEAN, EDWARD
506 MONTICELLO COURT
MARLTON, NJ 08053

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
MCLEISH, FREDERICK (RPH)
5 WINDSOR DRIVE
EGG HARBOR TOWNSHIP, NJ 08234

NPI-1447461504
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2017 Permanent
MCLEOD, MEGHAN AKA WHITE, MEGHAN (CHHA)
271 SERPENTINE DRIVE
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/8/2019
MCMAHON, THOMAS (MD)
121 WARWICK ROAD
HADDONFIELD, NJ 08033

NPI-1952309742
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/15/2016 Permanent
MCMURTRY-BURRELL, DIANE (RPH)
MDC BROOKLYN, PO BOX 329002
BROOKLYN, NY 11232

NPI-1609015015
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
MCMURTRY-BURRELL, DIANE (RPH)
MDC BROOKLYN, PO BOX 329002
BROOKLYN, NY 11232

NPI-1609015015
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MCNUTLEY, GEORGE, PRESIDENT
125 EAST BROADWAY
LONG BEACH, NY 11561

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/9/2016
MCPHERSON, KIMBERLY (CHHA)
110 THOMAS AVENUE
LAWNSIDE, NJ 08045

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
MCPHERSON, LEEANNE (RPH)
269 HAMPTON STREET
BRIDGETON, NJ 08302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/7/2008
MCQUEEN, BRITTANY (CHHA)
807 N. INDIANA AVENUE
ATLANTIC CITY, NJ 08401

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
MCRAE, CHANEL (CNA)
448 RAILROAD BLVD.
RICHLAND, NJ 08350

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/23/2006
MEDVEDIK, YELENA
2 HICKORY HILLS COURT
HOLMDEL, NJ 07733

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2013
MEDVEDOVSKY, ANDREW (MD)
11 AUTUMN DRIVE
MOORESTOWN, NJ 08057

NPI-1649431594
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/4/2020
MEEHAN, KATHLEEN AKA MEEHAN-KIERMIER, KATHLEEN (DMD)
1116 BENNETT DRIVE
WOODBURY, NJ 08096

NPI-1245445931
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2018 4/9/2019
MEHTA, MAHESH (MD)
157 RUTGERS PLACE
NUTLEY, NJ 07110

NPI-1396859385
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/2/2020
MEISHER, VLAD A. (PSYCH)
HILLSIDE TERR.
FAIR LAWN, NJ 07410

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
MEISHER, VLAD A. (PSYCH)
15-07-PLAZA ROAD APT. A
FAIRLAWN, NJ 07410

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/1/2009
MELENDEZ, JUANITA (COUNSELOR)
NORTH 35TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2003
MELENDEZ, LIZZADY (CHHA)
602 SOUTH 4TH STREET
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/26/2018
MELKER, NEIL L. (DMD)
219 VALLEY ROAD
PRINCETON, NJ 08540

NPI-1053443705
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2009
MELTZER, SCOTT M. (DMD)
70 WELLESLEY WAY
FREEHOLD, NJ 07728

NPI-1366561425
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2014 5/21/2020
MELTZER, SCOTT M. (DMD)
70 WELLESLEY WAY
FREEHOLD, NJ 07728

NPI-1366561425
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/3/2013 5/21/2020
MELYNYK, ARTEM, MEMBER
8653 GLENLOCH ST. #2
PHILADELPHIA, PA 19136

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/16/2012 11/15/2015
MEMBER, BERNARD J. (MD)
12335 S. ANNA DRIVE
ROCKVILLE, MD 23146

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
MENA, DANIEL
1002 TAUNTON AVE
WEST BERLIN, NJ 08091

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/16/2012 11/15/2015
MENDEL, RICHARD
701 SOUTH HOWARD AVENUE, SUITE 106
TAMPA, FL 33606

NPI-1306939202
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
MENDEZ, EDELFONSO (DO)
SMITH AVENUE
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/20/2008
MENDEZ, NORMA (CHHA)
60 BALDWIN STREET, #2
NEW BRUNSWICK, NJ 08901

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
MENSAH-NARH, STEVEN (RPH)
WEDGEWOOD DRIVE
NORTHBRUNSWICK, NJ 08902

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2007
MEO, JOHN
149 BOWNE ROAD
WAYSIDE, NJ 07712

NPI-1427086818
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/27/2009
MERVIL, DARLENE (CHHA)
122 ROSSITER AVENUE
PATERSON, NJ 07502

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/31/2018
MESA, NELSON (PCA)
964 GROVE STREET, APT. A
ELIZABETH, NJ 07202

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2017
MESSICK, PAULA (LPN)
105 SUMMIT AVENUE
EWING, NJ 08628

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/18/2009
MESSO, RALPH #67159-050 (MD)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08940

NPI-1184798621/1255309175
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/26/2018
MESSO, RALPH (MD)
2 RICHMONDE COURT
COLTS NECK, NJ 07722

NPI-1184798621/1255309175
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/28/2015
METTEAUX, IYANNAH (CHHA)
46 N. ARLINGTON AVENUE
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
METZ, DANIEL
FCI OTISVILLE #66799-050
OTISVILLE, NY 10963

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
MEYER, CYNTHIA (RN)
8200 KENNEDY BOULEVARD
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2018
MEYER, GLORIA
KINGS HIGHWAY
MIDDLETOWN, NJ 07748

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MEYER, JOSEPH
KINGS HIGHWAY
MIDDLETOWN, NJ 07748

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MEYERLE, GISELA (RN)
705 SUNFLOWER AVENUE
LANGHORNE , PA 19047

NPI-1356538169
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2018
MEYERLE, GISELA (RN)
705 SUNFLOWER AVENUE
LANGHORNE , PA 19047

NPI-1356538169
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2019
MEZERENEZ, MARIA (CHHA)
33 ASPEN PLACE
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/6/2018
MGBEME, FESTUS (RPH)
882 BROAD STREET
NEWARK, NJ 07114

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/8/2001 Permanent
AB Contracting & Develpement LLC
191 Central Ave 2nd Floor
Newark, NJ 07101

Michael Santos, President
988 Johnson Place Apt 4
Union, NJ 07083

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/27/2013 11/27/2013
A.V. Construction, Inc.
12 Verduci Drive
Newtown, PA 18940

Michael Verduci, President
12 Verduci Drive
Newtown, PA 18940

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/26/2015 05/25/2018
Michael, Lenec, Partner
300 Mamaroneck Avenue, #733
White Plains, NY 10605

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 06/29/2018
MICHAIL, MEDHAT (DDS)
848 BERGEN AVENUE
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/1998
Trinity Paving, LLC
115 Millstone Way
Monroeville, NJ 08343

Michele Doyle, Member
245 Clayton Rd
Monroeville, NJ 08343

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/21/2014 10/20/2017
Griffin Sign, Inc.
12 Pendleton Court
Medford, NJ 08055

Michelle Angerame, President
464 North Randolph Avenue
Cinnaminson, NJ 08077

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/14/2016 03/13/2019
MIKHAIL, PETER (RPH)
48 FALLON AVE.
ELMONT, NY 11003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2004 Permanent
MIKOS, KRISTEN (RN)
211 PRINCETON AVENUE
PHILADELPHIA, PA 19149

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
MIKSIS, MARY E. (RN)
126 WINSTEAD DRIVE
WESTAMPTON, NJ 08060

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/17/2004
MIL, PAUL
USP LEWISBURG #65099-050, PO BOX 1000
LEWISBURG, PA 17837

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/9/2017
MILANCE, HADZIC
164 MERLINE AVENUE
WOODLAND PARK, NJ 07424

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/3/2014 4/2/2017
MILLER, DEBBIE (DO)
94 EAST WATER ST
TOMS RIVER, NJ 08753

NPI-1750561866
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/26/2002 DECEASED
MILLER, DEIDRE
20 PERENNIAL LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/19/2001 Permanent
MILLER, DEIDRE, T.
92 RITTENHOUSE DRIVE
WILLINGBORO, NJ 08046

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/29/2000 Permanent
MILLER, JOSEPH M. (DO)
9 VICTORIA CIRCLE
JACKSON, NJ 08527

NPI-1255307856
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2015
MILLER, JUSTIN (PSYCH)
616 DALE COURT WEST
RIVERVALE, NJ 07675

NPI-1952594921
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/2/2017 Permanent
MILLER, RANDALL (DO)
1015 VAN HOUTEN AVE
CLIFTON, NJ 07013

NPI-1740342575
Medical
Wage & Hour Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

1/1/2001 4/6/2017
MILLER, ROY C.
703 WEST SHORE TRAIL
LAKE MOHAWK, NJ 07871

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MILLER, SANDRENE (MD)
50 UNION AVE., SUITE 401
IRVINGTON, NJ 07111

NPI-1912192527
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/25/1998
MILLER, SANDRENE A. (MD)
202 ELMWYND DRIVE
ORANGE, NJ 07050

NPI-1912192527
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/22/1999
MILLET, CYNTHIA (CHHA)
104 ROUTE 46 EAST
ELMWOOD PARK, NJ 07407

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/24/2017
MILMAN, BORIS
655 AMBOY AVENUE
WOODBRIDGE, NJ 07095

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/11/2001 Permanent
MILORADOVICH, VADIM (MD)
58 MERCER AVENUE
HARTSDALE, NY 10530

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2013
MILVIHILL, CHELSIE (CHHA)
501 MAPLE STREET
LAKEHURST, NJ 08733

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/18/2017
MIMS, CAROLE
1058 WILLOW STREET
NORRISTOWN, PA 19401

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MINATEE, SHERAI (LPN)
509 WARWICK ROAD
LAWNSIDE, NJ 08045

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/15/2018
MINNOW, MARY (CHHA)
9 WINDINGWOOD DRIVE
SAYERVILLE, NJ 08872

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/25/2001 Permanent
MIRAGLIA, ROBERT (LCSW)
254 VOSE AVENUE
SOUTH ORANGE, NJ 07079

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/9/2002
MIRANDA, MEREDITH (RPH)
3204 BLUE MOUNTAIN LANE
NAZARETH, PA 18064

NPI-1053740993
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
MIRASSOL, ISIDRO, PRESIDENT
20 CHERRY HILL LN. APT D
OLD BRIDGE, NJ 08857

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/28/2012 2/27/2015
MIRILASHVILI, MOSHE B. (MD)
PO BOX 350146
BROOKLYN, NY 11235

NPI-1427081223
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/17/1999 Permanent
MIRZA, MUHAMMED (MD)
145 GARRISON AVENUE
JERSEY CITY, NJ 07306

NPI-1467450262
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/8/2019 11/18/2019
MISHRA ARUNA (MD)
63 WEST BROADWAY
SALEM, NJ 08079

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/4/1997 Permanent
MISHRA, ARUNA (MD)
217B AUBURN ROAD
PILESGROVE, NJ 08098

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/3/2000 Permanent
MITRA, RANJIT (PSYCH)
2366 ST. GEORGES AVENUE
RAHWAY, NJ 07065

NPI-1417096942
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/12/2014
MITRA, RANJIT (PSYCH)
300 WOODBINE COURT APT1T
RIDGEWOOD, NJ 07450

NPI-1417096942
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
MITRESKI, IGOR (MD)
10 IVY LANE
WALLINGTON, NJ 07057

NPI-1629305255
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/26/2015
MITSUI, MASAO (MD)
9 BRIARWOOD ROAD
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2001
MOCKOVIAK, PATRICIA (LPN)
5 BEECH STREET
EDISON, NJ 08817

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
MODICA, JOSEPH (CHHA)
82 JEFFERSON STREET
SOUTH BOUND BROOK, NJ 08880

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
MOHAMED, ASHLI (CHHA)
10-4 FOUNTAIN AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
MOHAMED, ASHLI (CHHA)
10-4 FOUNTAIN AVENUE
TRENTON, NJ 08618

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

11/6/2018
A & H MEDICAL TRANSPORT.
PO BOX 8332
JERSEY CITY, NJ 07308

MOHAMED, HASHIM H.
P. O. BOX 8332
JERSEY CITY, NJ 07308

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/12/1994 Permanent
MOHAMMAD, OMAR (RPH)
15 GRISTMILL LANE
UPPER SADDLE RI, NJ 07458

NPI-1053580068
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012 5/17/2018
MOHAMMAD, OMAR (RPH)
15 GRIST MILL LANE
UPPER SADDLE RI, NJ 07458

NPI-1053580068
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/20/2012 5/17/2018
MOHAPELOA, GUGU (MD)
6 CORNELL ROAD
PARLIN, NJ 08859

NPI-1306952635
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/3/2019 Permanent
MOJICA, MARIA (CHHA)
108 BEECH STREET
PATERSON, NJ 07501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
MOLDAVER, INNA
32 BEACHWOOD AVENUE
EDISON, NJ 08837

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/17/2016
MOLINA, DANIEL (RPH)
320 EAST 42ND STREET, APT. 618
NEW YORK, NY 10017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
MONDELO, BARBARA AKA DOMINICO, MARIA AKA BARBARA TAYLOR J.
KENTWOOD BLVD
BRICK, NJ 08724

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/24/2008
MONFORTO, CHRISTINE (RN)
2620 HAMILTON DRIVE
VOORHEES, NJ 08043

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
MONICA, JULIANNE H. (DC)
509 ESSEX AVENUE
SPRING LAKE, NJ 07762

NPI-1235372608
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
MONK, SHENISE (LPN)
416 CHAMBERS AVENUE
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/24/2018
MONSUL, ROBERT W. (MD)
301 NORTH MAIN STREET
MANVILLE, NJ 08835

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

5/10/1990 Permanent
MONTE, LYDA (MD)
430 W. BROWNING ROAD, APT. M2
BELLMAWR, NJ 08031

NPI-1114068236
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/4/2018 Permanent
MONTE, LYDA (MD)
430 W. BROWNING ROAD, APT. M2
BELLMAWR, NJ 08031

NPI-1114068236
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2019
MONTES, NANCY (CHHA)
17-20 WELL DRIVE
FAIR LAWN, NJ 07410

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/1/2017
MONTGOMERY, FRANK
42 BRYANT ROAD
WARETOWN, NJ 08758

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/10/2014 7/9/2017
MONTORIO, JENNIFER (CHHA)
110 OUTER DRIVE
DINGMANS FERRY, PA 18328

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/11/2019
MOON, RASHIKA (RN)
2 JASON CIRCLE
PENNS GROVE, NJ 08069

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
MOONEY, MARY MELISSA (LPN)
777 CHERRY TREE ROAD
ASTON, PA 19014

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/23/2007
MOOR, JEAN (RN)
100 COLONIAL WAY
ALIQUIPPA, PA 15001

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MOORE, BRITTANY (CHHA)
141 BORDEN AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
MOORE, HANEEFAH (CHHA)
48 MONTROSE TERRACE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/3/2018
MOORE, JANE A. (RN)
235 KINGS ROAD
MADISON, NJ 07940

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
MOORE, JONATHAN R. (MD)
19 N. PEARL STREET
BRIDGETON, NJ 08302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/19/1997 Permanent
MOORE, LILLIE R.
353 S. CENTER ST., APT 19
ORANGE, NJ 07050

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
MOORE, LYNDA A. (LPN)
10719 JUREL CT. W. APT B
LAKEVILLE, MN 55044

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2005
MOORE, MONICA AKA OZERY, TZIPORA
27 FIRETOWER ROAD
BUDD LAKE, NJ 07828

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/15/2017
MOORJANI, KAMAL (RPH)
217 VAN BUREN STREET
LYNDHURST, NJ 07071

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/2010
MOORMANN, BARBARA ANN (CHHA)
2467 BREATHSTONE DRIVE
POWELL, OH 46065

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
MORALES SR., OSVALDO
78 W. 180TH STREET
BRONX, NY 10453

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2011
MORALES SR., OSVALDO
78 W. 180TH STREET 2ND FL
BRONX, NY 10453

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/13/2008
MORALES, ARLENE
254 NORTH 7TH STREET
NEWARK, NJ 07107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
MORALES, CHRISTINO
PO BOX 26883
PHILADELPHIA, PA 19134

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

7/2/2003
MORALES, CHRISTINO
328 MARKET STREET
CAMDEN, NJ 08102

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/5/2000
MORALES, FERNANDO (CNA)
346 S. MAIN STREET
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/21/2004
MORALES, JAMES (MD)
2319 CRYSTAL MILE COURT
TOMS RIVER, NJ 08755

NPI-1386649507/1013940006
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/11/2016 4/11/2016
MORALES, JAMES (MD)
16 WOODVIEW DRIVE
HOWELL, NJ 07731

NPI-1386649507/1013940006
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/11/2016
MORALES, JAMES (MD)
16 WOODVIEW DRIVE
HOWELL, NJ 07731

NPI-1386649507/1013940006
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/30/2017
MORALES, JUSTINA (CHHA)
62 HIGH STREET
WOODBURY, NJ 08096

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
MOREL, MARIA (CHHA)
735 TWENTY SECOND STREET
PATERSON, NJ 07504

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
MORELAND, CHARLOTTE (CHHA)
121 A PROSPECT VILLAGE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/29/2008
MORELAND, CHARLOTTE (CHHA)
121 PROPECT VILLAGE, APTA
TRENTON, NJ 08618

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2008
MORELLI, TIMOTHY J. (RPH)
801 BUTLER PIKE
MERCER, PA 16137

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
MORELOS, LISA A. (RN)
162 SHENANDOAH BLVD.
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2003
MORENO, BARTOLO (COUNSELOR)
2221 38TH STREET
PENNSAUKEN, NJ 08110

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2003
MORERA, JESSICA (CHHA)
116 DALTON STREET
ROSELLE PARK, NJ 07204

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
MORGANSTEIN, HENRY (DO)
774 CARTERET COURT
MT. LAUREL, NJ 08054

NPI-1689730343
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2010
MORGANSTEIN, HIRAM N. (OD)
5618 BERGENLINE AVENUE
WEST NEW YORK, NY 07093

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/22/2001 Permanent
MORIARTY, JACK
312 GRANDE RIVER BLVD.
TOMS RIVER, NJ 08755

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/8/1999 Permanent
MORIZZO, SANDRA (MEMBER)
311 HOLYOKE
BEACH HAVEN, NJ 08008

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/20/2012 12/19/2015
MORRIS, CANDICE (CHHA)
154 NORTH SPRING STREET, UNIT B
BLOOMFIELD, NJ 07003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/22/2018 Permanent
MORRIS, CHRISTINE (CHHA)
323 KAIGHN AVENUE
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/16/2018
MORRIS, JOHN
70 TUCKERTON ROAD
MEDFORD, NJ 08055

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001 Permanent
MORRISON, JAMES C. (MD)
RADIO RD AT EAST BOAT
TUCKERTON, NJ 07087

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
MORTON, MARION (RPH)
2321 SPRUILL AVE, APT 917
NORTH CHARLESTON, SC 29405

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

2/6/2012
MOSHKOVITCH, VASIL (MD)
41 NAUTILUS DRIVE
MANAHAWKIN, NJ 08050

NPI-1326116419
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/2016 Permanent
MOSHKOVITCH, VASIL (MD)
41 NAUTILUS DRIVE
MANAHAWKIN, NJ 08050

NPI-1326116419
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017 Permanent
MOSKOWITZ, MYRON (DPM)
705 RIDGE DRIVE
UNION, NJ 07083

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
MOSS, ALBERT H. (MD)
28 BARTLE ROAD
SOMERSET, NJ 08873

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
MOSS, ROBERT H. (DPM)
244 N. MAIN STREET
MULLICA HILL, NJ 08062

NPI-1881716348
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/2/2011
MOSS, ROBERT H. (DPM)
244 NORTH MAIN STREET
MULLICA HILL, NJ 08062

NPI-1881716348
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2013
MOSS, ROBERT H. (DPM)
244 NORTH MAIN STREET
MULLICA HILL, NJ 08062

NPI-1881716348
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MOSSAVI, AHMAD (MD)
7 MALKE DRIVE
OCEAN, NJ 07712

NPI-1629046248
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/23/2012
MOTA, KAESHA (CHHA)
433 N. 7TH STREET
CAMDEN, NJ 08102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
MOTT, TARA (RN)
3557 SHARON ROAD
WEST MIDDLESEX, PA 16159

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
MOULDER, DARIA (PHARM TECH)
2715 BAYSHORE ROAD
VILLAS, NJ 08251

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2010
MOURACHOV, PAVEL
3917 WEST ROAD, SUITE 137
LOS ALAMOS, NM 87544

NPI-1083711121
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
MOWERY, SHAWN F.
1A MAPLE LEAF DRIVE
HOLMDEL, NJ 07723

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/12/2013 3/11/2016
MOZULAY, MARK J. (MD)
512 TOWNSHIP LANE
BLUE BELL, PA 19422

NPI-1669631719
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/1/1998
MUHAMMAD, ABDUL B. (MD)
284 BROADWAY
NEWARK, NJ 07104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/8/2004 Permanent
MUHAMMAD, DIAMONNIQUE (CHHA)
354 7TH AVENUE WEST
NEWARK, NJ 07107

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
MUID, JANNAH
671 LINCOLN AVE
ORANGE, NJ 07050

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2010
MUISE, NICOLLETE (CHHA)
172 FRANKLIN ROAD
DENVILLE, NJ 07834

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/8/2017
MUKHTAR, JUNAID
114 BALDWIN AVENUE
JERSEY CITY, NJ 07306

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/5/1997
MULLANGI, KUMAR R. (MD)
SOUTH BROADWAY STREET
BURLINGTON, IA 52601

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2008
MULLER JR., RAYMOND E. PRES.
75 WEST 3RD AVE.
PINE HILL, NJ 08021

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/7/2012 2/6/2015
MULLIGAN, RACHEL M.
241 HAWAII DRIVE
BRICK, NJ 08723

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/11/2008
MULTANI, GURMEET (PSYCH)
1055 CALLE DE LAS PALM
REDLANDS, CA 92373

NPI-1528225406
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/9/2011
MUNGEN, JONETTA V. (CHHA)
34 VERMONT AVENUE
NEWARK, NJ 07106

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
MUNN, DONIELLE (CHHA)
150 HOME AVENUE, FL. 2
TRENTON, NJ 08611

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
MUNOZ, GUILLERMO (DO)
395 SPRING STREET
UNION, NJ 07083

NPI-1023071669
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/25/2015 5/13/2016
MUNOZ, JULIO ANTHONY
4 NORMAL AVENUE
UPPER MONTCLAIR, NJ 07043

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/26/2006
MUNSIF, ANAND (MD)
127 E. NORTHFIELD ROAD
LIVINGSTON, NJ 07039

NPI-1982879805
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/7/2011
MUNZEL, GREGORY THOMAS
140 WAPPOO CREEK DRIVE
CHARLESTON, SC 29412

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

4/22/2012
MURATORE JR., FRANK J.
1828 HERBERT BOULEVARD
WILLIAMSTOWN, NJ 08094

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/10/2012 10/9/2015
MURRAY, LAKIRAH (LPN)
1311 NE 77TH AVENUE
GAINESVILLE, FL 32609

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/5/2018
THE EXCEL CENTER, INC.
104 WINDSOR COURT
PALM BEACH, FL 33480

MURRY JR., TOMMIE
2697 RAVEN ROAD
CINNAMINSON, NJ 08077

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/25/1999 Permanent
THE EXCEL CENTER, INC.
104 WINDSOR COURT
PALM BEACH, FL 33480

MURRY JR., TOMMIE
2697 RAVEN ROAD
CINNAMINSON, NJ 08077

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/5/2001 Permanent
THE EXCEL CENTER, INC.
104 WINDSOR COURT
PALM BEACH, FL 33480

MURRY JR., TOMMIE
2697 RAVEN ROAD
CINNAMINSON, NJ 08077

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/20/2002
MUSCARRA, GERALD C. (DMD)
525 WASHINGTON AVENUE
HOBOKEN, NJ 07030

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
MUSCIO, ROBERT (MD)
333 BROAD STREET
RED BANK, NJ 07701

NPI-1578510723
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/19/2015
MUZZIO JR., WILLIAM
597 LYMAN AVENUE
WOODBRIDGE, NJ 07095

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/15/2013 1/14/2016
MYERS, HOWARD (MD)
103 FAIRWAY TERRACE
DOWNS, NJ 08054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
MYNDIUK, JAROSLAW (MD)
96 TUXEDO PARKWAY
NEWARK, NJ 07106

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

2/27/1988 DECEASED
MYSZKA, KENNETH C. PRESIDENT
7095 SHAFFER DRIVE
DOWNS, IL 61736

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/28/2012 2/27/2015
n/a
300 Mamaroneck Ave. #733
White Plains, NY 10605

n/a

,

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 6/29/2018
NAGLE, BRITTANY (RN)
709 NORTH VICTORIA AVENUE
VENTNOR CITY, NJ 08406

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
NAIMOLI, DANIELLE
824 HOLIDAY COURT
TOMS RIVER, NJ

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/30/2005
NALBONE, PHILLIP C. (RN)
24 RUNNING BROOK ROAD
TRENTON, NJ 08638

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/17/2004
NANDI, ANINDITA (MD)
127 HIGHLAND AVENUE
JERSEY CITY, NJ 07306

NPI-1669563995
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2018
NAPENAS, VICTOR
14 SPRUCE LANE
PISCATAWAY, NJ 08854

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2012
NAPENAS, VICTOR T.
14 SPRUCE LANE
PISCATAWAY, NJ 08854

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/17/2011
NARAYAN, PRITHVI (MD)
33 COOPER AVENUE, UNIT 213
LONG BRANCH, NJ 07740

NPI-1982699823
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/25/2021 Permanent
NARO, MARYANN (LPN)
23 DOWNING ROAD
HAMILTON, NJ 08690

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/25/2019
NASH, JENNIFER (RN/APN)
621 ASTER LANE
RIVERVALE, NJ 07675

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/3/2016
NASH, LEONARD
TALL OAKS CT.
FRANKLIN LAKES, NJ 07417

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/27/2000
NASSERY, MOHAMMAD (MD)
59 TREELINE DRIVE
MARSTON MILLS, MA 02648

NPI-1992763510
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/9/2016
NATALE, JOSEPH
216 NORTH AVENUE E STE2
CRANFORD, NJ 07016

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/24/2014
NATHAN, MICHAEL (MD)
1 PROSPECT LANE
OKATIE, SC 29909

NPI-1578593422
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/1/2017
NATOVICH, BORIS
996 PINE TERRACE
FRANKLIN LAKES, NJ 07417

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

9/18/2003
NATOVICH, LEV
996 PINE TERRACE
FRANKLIN LAKES, NJ 07417

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

9/18/2003
MKM NURSING HOME SPEC.INC
1368 BRENTWOOD ROAD
YARDLEY, PA 19067

NAVAZIO, DAVID
1368 BRENTWOOD ROAD
YARDLEY, PA 19067

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/7/2000 1/5/2018
NAYLOR, KIM M. (PHARM TECH)
1504 TAMIAMI ROAD
FORKED ROAD, NJ 08731

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/19/2011
NAZARIO, JULISSA (CHHA)
210 ROSEVILLE AVENUE, APT. C-1
NEWARK, NJ 07107

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
NEAL, LAYONA (CHHA)
545 E. TOILE COURT
BURLINGTON, NJ 08016-

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/13/2018
NEALS, SHERRY (CHHA)
63 DALES AVE, APT. 1124
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2001
NEGRI, MARY JANE (DC/RN)
514 LAFAYETTE ROAD SUITE F
SPARTA, NJ 07871

NPI-1063594836
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2015
NEGRON, JOANNA (CHHA)
1343 LANDSDOWNE AVENUE
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
Nelson DeOliveira, President
276 Highland Ave
KEARNEY, NJ 07032

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/12/2014 8/11/2017
NELSON, SIDNEY (MD)
4517 BERGENLINE AVENUE
UNION CITY, NJ 07087

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/13/1999 Permanent
NESSMAN, LAWRENCE (DO)
143 GREENRALE AVENUE
WAYNE, NJ 07470

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/24/1997 Permanent
NDA & Construction, LLC
161 Thomas St Unit 1
Newark, NJ 07114

Nester Torres, Owner
161 Thomas St Unit 1
Newark, NJ 07114

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/11/2014 12/10/2017
NEWBY, YVONNE (CHHA)
38 WINANS STREET, APT. 3
EAST ORANGE, NJ 07018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2017
NEWMAN, ALEXANDER (PHD)
372 N. WOODLAND STREET
ENGLEWOOD, NJ 07631

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/10/1999 Permanent
NEWMAN, MICHAEL J. (DMD)
192 GABRIEL TERRACE
SOUTH AMBOY, NJ 08879

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
NEWMARK, MALINDA (RN)
38 STONY HILL ROAD,APT101
MONROE TOWNSHIP, NJ 08831

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
NEWMARK, THOMAS (MD)
225 CHAPEL AVENUE
CHERRY HILL, NJ 08002

NPI-1740380997
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/2016 Permanent
NEWMARK, THOMAS (MD)
4700 CITY AVENUE, APT. 11307
PHILADELPHIA, PA 19131

NPI-1740380997
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/17/2017 Permanent
NEWSOME, DORITA (DDS)
163 CHAPEL STREET
ORANGE, NJ 07050

NPI-1306063235
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2009
NEWTON, ANDREW (PSYCH)
129 EAST 5TH STREET
MOUNT CARAMEL, PA 17851

NPI-1154349330
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
NEYMET, ALLA (CHHA)
127 GARDEN TERRACE
EDISON, NJ 08817

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/29/2018
NGOAJIA, MARK
403 WILLOW POINT DRIVE
JACKSON, NJ 08527

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
NGUYEN, TONY (MD)
10294 GREENSPIRE DRIVE
OAKTON, VA 22124

NPI-1083872675
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/28/2017
NIAZ, ASIM
P.O. BOX 420
FAIRTON, NJ 08320

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/19/2010
NICHOLSON, BEVERLY (CNA)
139 HOLLYWOOD AVENUE
EAST ORANGE, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/13/2006
NT&P Construction Inc.
4 Camelot Ave
Monroe Township, NJ 08831

Nicola Pengue, President
105 White Oak Lane
Old Bridge, NJ 08857

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/23/2015 11/22/2018
Terra-Tech Construction, Inc.
12 Red Fox Run
Manalapan, NJ 08857

Nicole Lucas, President
265 Woodward Rd
Manalapan, NJ 07726

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/18/2015 03/17/2018
NICOLL, DAVID G.
312 BOULEVARD
MOUNTAIN LAKES, NJ 07046

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/21/2015 7/4/2019
NICOLL, DAVID G. #65321-050
USP CANAAN, PO BOX 300
WAYMART, PA 18472

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/4/2019
NICOLL, SCOTT R.
120 BUNKER HILL ROAD
WAYNE, NJ 07470

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/21/2015
NICOSIA, BETTY LOU
204 CIRCLE DRIVE
STEUBEN, OH 43953

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
NIELSON, STEVEN C. (DPM)
845 DAWN AVENUE
EPHRATA, PA 17522

NPI-1538595772
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/23/2009
NIGALAN, MANUEL (MD)
8 MIMI COURT
NORTHFIELD, NJ 08225

NPI-1497809909
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/14/2010
NII, ROBERT (PA)
34 MILL BROOK ROAD
PISCATAWAY, NJ 08854

NPI-1124254107
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/21/2016 Permanent
NINOS, DIANE E.
569 E. 33RD STREET
PATERSON, NJ 07613

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2001 Permanent
NISBETT, MELVIN (CHHA)
205 LA CASCATA
CLEMENTON, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
NISIVOCCIA, CHARLES (DC)
260 MAIN STREET
LITTLE FALLS, NJ 07424

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2006
NISLER, JANIS (RN)
127 WEST WOODBRIDGE AVENUE
ISELIN, NJ 08830

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/24/2019
NOBLES, MARITZA (CHHA)
34 CENTER OAK AVENUE
LAWNSIDE, NJ 08045

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
NOBORE, ABIEYUWA (CHHA)
776 SOUTH 13TH STREET
NEWARK, NJ 07108

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2017
Noe's Concrete Inc
30 Euclid Ave
Medford, NY 11753

Noe Alatorre, Owner
30 Euclid Ave
Medford, NY 11763

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/7/2013 06/06/2016
Chanez Landscaping, LLC
PO Box 5646
New Brunswick, NJ 08903

Noe Chanez, Principal
55 Miller Ave.
Somerset, NJ 08873

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

9/24/2014 09/23/2017
NOE, ALATORE
30 EUCLID AVENUE
MEDFORD, NJ 11753

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/7/2013 6/6/2016
NOEL, EDWARD (LPN)
469 E. 93RD STREET, APT. 6
BROOKLYN, NY 11212

NPI-
Medical
Wage & Hour Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2019
NONCENT, JENNIFER (CHHA)
949 CARTERET AVENUE
UNION, NJ 07083

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
NONZIATO, CHARLES G. (DO)
247 CENTER STREET
TRENTON, NJ 08611

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

11/13/1991 DECEASED
NOOR, FARID A. (MD)
5 GITHERS LANE
MEDFORD , NJ 08055

NPI-1770751513
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/12/2004
NOOR, FARID A. (MD)
596 ANDERSON AVENUE
CLIFFSIDE PARK, NJ 07010

NPI-1770751513
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/30/2015
NOOR, FARID A. (MD)
350 A DELANCEY PLACE
MOUNT LAUREL, NJ 08054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/19/2008
NORDMAN, CRAIG J.
4 ERNA PLACE
WHIPPANY, NJ 07981

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/21/2015
NORDMAN, CRAIG J.
FCI SCHUYLKILL, PO BOX 759
MINERSVILLE, PA 17954

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
NOWINSKI, VANESSA AKA AMATO, VANESSA A. (RN)
65 LOCUST AVENUE
N. ARLINGTON, NJ 07031

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
NSIAH, KENNETH (CHHA)
827 S. 17TH STREET, 2ND FLOOR
NEWARK, NJ 07108

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/14/2017
NTSHONA, NOKUZOLA S. (MD)
113-15 34TH AVE, #4B
CORONA, NY 11368

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/12/2000 Permanent
Cunhas Construction Inc.
35 Carmen Ct Floor 1
Newark, NJ 07105

Nuno Cunha, Owner
35 Carmen Ct Floor 1
Newark, NJ 07105

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/23/2014 10/22/2017
NURIK, BARUCH
APT 9C PARKVIEW & MADISON
LAWRENCE HARBOR, NJ 08879

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/1995 Permanent
NUSSBAUM, ABRAHAM (MD)
91 MONTGOMERY STREET
RHINEBECK, NY 12572

NPI-1578598082
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/15/2001 11/12/2013
NUTT, TRACY (RN)
27 OVERLOOK DRIVE
MOUNT LAUREL, NJ 08054

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/11/2019
NWANKWO, FESTUS (RPH)
154 BLOOMFIELD AVENUE
NEWARK, NJ 07104

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/1998 Permanent
NWANKWO, FESTUS (RPH)
306 ARDSDALE TERRACE
UNION, NJ 07083

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/18/1999 Permanent
PARK AVENUE PHARMACY
278 PARK AVENUE
NEWARK, NJ 07107

NWANKWO, RAPHAEL
278 PARK AVENUE
NEWARK, NJ 07107

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/19/1999 Permanent
O'CALLAGHAN, TERESE (RN)
5122
ORCHARD WAY, NJ 08109

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
OCANSEY, DONNA (RN)
7 WISINA COURT
MEDFORD, NJ 08055

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

4/22/2012 7/19/2019
OCCEAN, NERLANDE (CHHA)
811 DILL AVENUE
LINDEN, NJ 07036

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
O'CONNELL, MARK (MD)
18 CENTER STREET, REAR
RUMSON, NJ 07760

NPI-1669514253
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/9/2015
O'CONNELL, TOM OWNER
499 GRACE HILL ROAD
MONROE, NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2013 2/10/2016
ODEH, MOHD, OWNER OFFICER
234 BATHGATE AVE.
FRANKLIN, NJ 08873

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/19/2012 1/18/2015
ODOMS, TIFFANY E.
926 TILGHMAN STREET
CHESTER, PA 19013

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2008
O'DONNELL, KATHERINE
141 MAIN STREET
METUCHEN, NJ 08840

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2005
O'DONNELL, LISA (RN)
845 BROADWAY
BAYONNE, NJ 07002

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2018
O'DONNELL, WILLIAM (DC)
7 NINEBARK LANE
OXFORD, NJ 07863

NPI-1659601177
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2019
ODUNZEH, UCHE
3565 LAUREL FORTE MEADE RD., APT. 41
LAUREL, MD 20724

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
OFFOR, CHINWE (MD)
15 CHABLIS DRIVE
DIX HILLS, NY 11746

NPI-1508811019
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/12/2019
OFFOR, CHINWE (MD)
15 CHABLIS DRIVE
DIX HILLS, NY 11746

NPI-1508811019
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/11/2019
OGANDO, ERNESTINA (CHHA)
943 SHERIDAN AVENUE
ELIZABETH, NJ 07208

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/18/2017 6/28/2018
OGBEIDE-SIMMS, RACHEL (CHHA)
15 MAPES PLACE, APT. 2
NEWARK, NJ 07112

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
OGORODOVA, GANNA (CHHA)
310 BROMLEY PLACE
EAST BRUNSWICK, NJ 08816

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
OGUNTUASE, EBENEZER (PSYCH)
10 DOCKSIDE DRIVE
EGG HARBOR, NJ 08234

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2009
O'HERN, DANIEL (MD)
18 FLEETWOOD DRIVE
GOSHEN, NY 10924

NPI-1144369554
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017 Permanent
OJIKYTU, SIMBIAT T. (CHHA)
51 LEXINGTON BLVD
BARNEGAT, NJ 08005

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2014
OJO, RICHARD O.
346 FIELDCREST AVENUE
NEW EGYPT, NJ 08533

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/24/2009
OKANTAH, MARGARET (CHHA)
1854B MANOR DRIVE
UNION, NJ 07083

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/30/2005
HEALTHCORE PHARMACY
289 GEORGE STREET
NEW BRUNSWICK, NJ 08901

OKOYE, GOODWIN S. (RPH)
289 GEORGE STREET
NEW BRUNSWICK, NJ 08901

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/12/2001 Permanent
HEALTHCORE PHARMACY
289 GEORGE STREET
NEW BRUNSWICK, NJ 08901

OKOYE, PATRICK C. (RPH)
289 GEORGE STREET
NEW BRUNSWICK, NJ 08901

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/12/2001 Permanent
OKREM, JANINE (RN)
1112 HARKER AVENUE
WEST DEPTFORD, NJ 08096

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/12/2018
OLEJNIOK, ROMAN PRESIDENT
1882 PUTNAM AVENUE
RIDGEWOOD, NY 11385

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/26/2012 3/25/2015
Olga Conteras, Vice-President
677 Old Highway 64
Etowah, NC 28729

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/20/2015 10/19/2018
OLIVEIRA JR., MARIO (OD)
170 EAST KINNEY STREET
NEWARK, NJ 07105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/28/2005
OLIVER, ANDREA AKA SCHLEMBACH, ANDREA (APN/RN)
70 COHANSEY STREET
BRIDGETON, NJ 08302

NPI-1780630418
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016 5/21/2020
OLIVER, JAMES (DDS)
167 MAIN STREET
METUCHEN, NJ 08840

NPI-1134314594
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/13/1999 Permanent
OLIVERA, PABLO R. (DPM)
2 CEDAR STREET
NEWARK, NJ 07102

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2001
OLIVERA, SMIRNA (LPN)
33 REMSEN AVENUE
NEW BRUNSWICK, NJ 08901

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
OLIVEROS, APRIL (LPN)
233 SMOKERISE LANE
TOMS RIVER, NJ 08755

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
OLIYNYK, OKSANA (CHHA)
591 MARLBORO ROAD
OLD BRIDGE, NJ 08857

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2017
MUGAHID MEDICAL SHUTTLE
1116 ANNE STREET
ELIZABETH, NJ 07201

OMAR, HATIEM AKA HATIM
1116 ANNE STREET
ELIZABETH, NJ 07201

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/10/1999 Permanent
EMPIRE STATE MEDICAL SVCS
144 ELMORE AVENUE, SUITE 204
ELIZABETH, NJ 07201

OMAR, MUGAHID
7-11 TONNELE AVENUE
JERSEY CITY, NJ 07306

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/14/1998 Permanent
OMAR, MUGAHID O.
7-11 TONNELLE AVE-2MN
JERSEY CITY, NJ 07306

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/10/1997 Permanent
O'NEILL - RYAN, LISA ANNE (COUSELOR)
415 LYNDALE STREET
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/9/2008
O'NEILL-RYAN, LISA ANN (COUNSELOR)
415 LYNDALE STREET
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/17/2008
ONYEKAHA, EBERE (RPH)
13 HIGHLAND AVENUE
MAPLEWOOD, NJ 07040

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
ONYENSO, CHIKEZIE (MD)
552 MAIN STREET
CHATHAM, NJ 07928

NPI-1578605812
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/15/2012 5/6/2021
ONYENSO, CHIKEZIE (MD)
18 EDINBURGH DRIVE
RANDOLPH, NJ 07869

NPI-1578605812
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/19/2015 5/6/2021
OPOKU, BISMARK (CHHA)
2468 ANGLER ROAD
COLUMBUS, OH 43224

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/6/2018
OPRZADEK, KRZSTOF
19 WOODVILLE ROAD
HOPEWELL, NJ 08525

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2015 2/10/2018
OQUENDO, BASHIRAH (CHHA)
87 MANNING AVENUE
PLAINFIELD, NJ 07060

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
O'REILLY, MARGARET (RN)
38 REILEY MOUNTAIN ROAD
CUDDEBACKVILLE, NY 12729

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/25/2019
O'REILLY, RAYMOND B.
188 ALEXANDRIA DR APTS
HACKETTSTOWN, NJ 07840

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
OREM, SUSAN (RN)
140 VALERIE DRIVE #488
MANVILLE, NJ 08835

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2006
ORIA, CONRAD (RN)
525 BLOOMFIELD AVENUE
CALDWELL, NJ 07006-

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/5/2017
ORT II, CHARLES C. (PA)
P.O. BOX 481
HACKETTSTOWN, NJ 07840

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/18/2004 Permanent
ORTEGA, ANA (CHHA)
14 PALM STREET
MONMOUTH JUNCTION, NJ 08852

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
ORTEGA, VICTOR
GUAYNBO- PO BOX 2147
SAN JUAN, PR 00922

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/18/2002
ORTELL, CARL (RPH)
221 TINDERBOX LANE
MARLTON, NJ 08053

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/5/1983 Permanent
OSAIGBOVO, ASHLEY (CHHA)
130 PAMPHYLIA AVENUE, APT. #70
BRIDGETON, NJ 08302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/19/2017
OSEI, CALVIN (RPH)
2 SYSLO COURT
SAYREVILLE, NJ 08872

NPI-1497931794
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/2012 6/12/2018
OSEI, FRANCIS (LPN)
50 N. EVERGREEN ROAD, APT. 170M
EDISON, NJ 08837

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/24/2017
OSEI, PASCAL
9 SOUTH GROSSER PLACE
SOMERSET, NJ 08873

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2009 7/17/2014
OSIFO, BAHEEJAH (CHHA)
530 PARK AVENUE
ORANGE, NJ 07050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
OSMANOFF, GARY (DDS)
NETTER COURT
MARLBORO, NJ 07746

NPI-1710188073
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/23/2008
OSMANOFF, GARY (DDS)
317 MARINE AVENUE
BROOKLYN, NY 11209

NPI-1710188073
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

12/17/2008
OSTERGAARD, PAUL (MD)
230 WEST PARKWAY
POMPTON PLAINS, NJ 07444

NPI-1962504753
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/16/2015
OSTERGAARD, PAUL (MD)
230 WEST PARKWAY
POMPTON PLAINS, NJ 07444

NPI-1962504753
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/21/2014
OSTERGAARD, PAUL (MD)
15 MOUNTAIN AVENUE
POMPTON PLAINS, NJ 07444

NPI-1962504753
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
OSTROSKIE, JOAN (LPN)
424 FLORENCE STREET
NEW MILFORD, NJ 07646

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/19/2003
OSTWALD, ALICE (LPN)
11 RAILROAD LANE
WHITEHORSE , NJ 08889

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2006
OSUJI, PAUL
FCI FORT DIX PO BOX 2000
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2009
OSWARI, DANIEL (MD)
35 ALLEGHENY LANE
BORDENTOWN, NJ 08505

NPI-1265506489
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/30/2020
OTI, CHUCK B.
676 PARK AVE., BLDG. 14B
EAST ORANGE, NJ 07017

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2000 Permanent
OTOO, LOVE (CHHA)
555 ELIZABETH AVENUE
NEWARK, NJ 07112

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
OTTENSTEIN, ALAN (MD)
3100 PRINCETON PIKE
LAWRENCEVILLE, NJ 08648

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/1/2009
OTTENSTEIN, ALAN (MD)
173 MOUNT EYRE RD.
WASHINGTON CROS, PA 18977

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
OWUSU, NICHOLAS (CHHA)
6063 HAMPSTEAD DRIVE W
COLUMBUS , OH 43229

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/27/2017 Permanent
OWUSU-ANSAH, GRACE (CHHA)
97-22 57TH AVENUE
CORONA, NY 11368

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/17/2018
OXMAN, REED S. (MD)
226 W. RITTENHOUSE SQUARE
PHILADELPHIA, PA 19103

NPI-1649575473
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/16/2012
OYENUSI, ADEBOWALE (RPH)
90 WASHINGTON STREET
EAST ORANGE, NJ 07017

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/14/2000 Permanent
OZERY, TZIPORA AKA MOORE, MONICA
27 FIRETOWER ROAD
BUDD LAKE, NJ 07828

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/15/2017
PABBATHI, RAMMOHAN
3 AMY COURT
HOWELL, NJ 07731

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/8/2005
GLV PARKE WARNER PHCY
481 EDWARD H ROSS DRIVE
ELMWOOD PARK, NJ 07407

PACHECO, ALVARO R.
59 EDGEHILL COURT
WEST ORANGE, NJ 07052

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
PACHECO, MICHAEL (PHARM TECH)
84 LAFAYETTE AVE.
PASSAIC, NJ 07055

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2003
PADUANO JR., FRANCIS P. (RPH)
2020 BALMORAL AVE.
UNION, NJ 07083

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/1986 Permanent
PADVA-GERMAN, ANNA (DDS)
446 DUBLIN PLAZA
SECAUCUS, NJ 07094

NPI-1043382039
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

12/14/2009 3/24/2021
PADVA-GERMAN, ANNA (DDS)
446 DUNLIN PLAZA, 446H
SECAUCUS, NJ 07094

NPI-1043382039
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

10/15/2014 3/24/2021
PAGANO, NICOLE (RN)
531 PARKWAY AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2009
PAGONZAGA, GLORIA (CHHA)
313 OLD BERGEN ROAD, APT. 2
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
PAKETT, NEIL (DMD)
777 WEST GERMANTOWN PIKE, APT. 530
PLYMOUTH MEETING, PA 19462

NPI-1184934663
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PALMER, AMANDA (LPN)
14 E. MAIN STREET, APT. 4
CLINTON, NJ 08809

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/13/2019
PALMER, THOMAS #14570-003 (RN)
FPC PENSACOLA, PO BOX 3949
PENSACOLA , FL 32516

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/29/2017
PAMIKIMUKKALA, VIJAY (RPH)
3 PENROSE COURT
EDISON, NJ 08820

NPI-1598087272
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/13/1999
PANCELLI, JOHN M. (MD)
WEST JERSEY HOSPITAL
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 DECEASED
PANGANIBAN, ARMANDO (RN)
CYPRESS RD.
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/11/2007 Permanent
PANICHELLA, ANTHONY G. (COUNSELOR)
739 S. WHITE HORSE PIKE,
AUDUBON, NJ 08106

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2006
PANITCH, EDWIN (RPH)
8 POINT OF WOODS DRIVE
NORTH BRUNSWICK, NJ 08902

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
PANJWANI, HARRY K. (MD)
EAST 42 FAIRVIEW TERRACE
PARAMUS, NJ 07652

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/24/1999 Permanent
PANOS, SPYROS (MD)
#69361-054 USP CANAAN, PO BOX 300
WAYMART, PA 18472

NPI-1497753149
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PAPANDREA, JANICE, PRESIDENT
1065 JOHNSON DRIVE
WATCHUNG, NJ 07060

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/19/2012 4/18/2015
PAPPALARDO, PETER S. (MD)
4 SOUTH AIRMONT RD
SUFFERN, NY 10901

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
PARADISO, NINO
57 POPLAR DRIVE
MORRIS PLAINS, NJ 07950

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/9/2016
PARASHOS, LINDA (RN)
514 9TH AVENUE
LINDENWOLD, NJ 08021

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
PARCHMENT, ALFRED (MD)
1140 BURNT TAVERN ROAD
BRICK, NJ 08724

NPI-1073587242
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2016
PAREKH, CHANDRAKANT (DDS)
6529 GERMANTOWN AVENUE
PHILADELPHIA, PA 19119

NPI-1144386178
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PARIDA, SAROJ K.
USP LEWIS-PO BOX 1000
LEWISBURG, PA 17837

NPI-1013975549
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2013
PARIKH, BIPIN (MD)
224 LAFAYETTE STREET
WILLISTON PARK, NY 11596

NPI-1962555193
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2010
PARIKH, BIPIN J. (MD)
224 SOUTH LAFAYETTE STREET
WILLISTON PARK, NY 11596

NPI-1962555193
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/9/2008
PARIKH, MANUPRASAD (RPH)
209 STOKES FARM ROAD
FRANKLIN LAKES, NJ 07417

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2004 9/5/2017
PARKOFF & HAMMER P A
253 ROSEVILLE AVE
NEWARK, NJ 07107

PARKOFF, MICHAEL A. (DMD)
68 MAPLEWOOD BLVD
SUFFERIN, NY 10901

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/1984 Permanent
PASCUCCI, LAVERNE (CHHA)
160 JAMES STREET
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
PATANKAR, SANJIV (MD)
61 HARDWICK DRIVE
KENDALL PARK, NJ 08824-

NPI-1255429361
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/19/2017
PATEL, ARUNA S. (MD)
725 NORTH BROAD STREET
ELIZABETH, NJ 07208

NPI-1770568610
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/26/2008
PATEL, ASHOKKUMAR R.
YARDLEY STREET
EDISON, NJ 08820

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
PATEL, BELA (RPH)
1701 COTTMAN AVENUE
PHILADELPHIA, PA 19111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/9/2015
PATEL, BHARAT KUMAR (RPH)
140 RIVERSIDE BLVD.
NEW YORK, NY 10069

NPI-1962729731
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2014
CLIN-MED LABORATORIES INC
40 GALESI DRIVE
WAYNE, NJ 07470

PATEL, CHANDRAKANT
40 GALESI DRIVE
WAYNE, NJ 07470

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/28/2000 12/12/2007
PATEL, CHIRAG
16 SNEIDER ROAD
WARREN, NJ 07059

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/2/2012
PATEL, CHIRAG J.
16 SNEIDER ROAD
WARREN, NJ 07059

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/20/2015
PATEL, DINESH R. (MD)
3 BRIGHTON COURT
LIVINGSTON, NJ 07039

NPI-1285702829
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/27/2017
PATEL, DINESH R. (MD)
3 BRIGHTON COURT
LIVINGSTON, NJ 07039

NPI-1285702829
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/17/2012
PATEL, DINESH R. (MD)
835 CLINTON AVENUE
NEWARK, NJ 07108

NPI-1285702829
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2014
PATEL, HARISH AKA HARRIS, PAUL (MD)
GB-46 PO BOX 26010
BEAUMONT, TX 77720

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
PATEL, MAHESH (MD)
3 PINE VALLEY WAY
FLORHAM, NJ 07932

NPI-1942202841
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/26/2015 11/9/2020
PATEL, MEHMOOD (MD)
201 MIDDLETON ROAD
LAFAYETTE, LA 70503

NPI-1225074859
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2010
PATEL, PARESH R. (DMD)
295 MAIN STREET
METUCHEN, NJ 08840

NPI-1134106511
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/22/2014
PATEL, PARESHCHANDRA
8 NOTTINGHAM ROAD
EDISON, NJ 08820

NPI-1306073200
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/21/2016
PATEL, PRAVIN K. (MD)
904 #35 IVY RIDGE RD
SYRACUSE, NY 13210

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/19/2002
PATEL, RAMBEN D. (LPN)
505 WEST MINISTER BLVD.
PARLIN, NJ 08859

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2000
PATEL, RAMESH SHANKER BHAI (RN)
PO BOX 5564
OLD BRIDGE, NJ 08857

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2001
PATEL, RITA (RPH)
4 HAUSER LANE
MATAWAN, NJ 07747

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/20/2017 10/19/2017
PATEL, RITA (RPH)
4 HAUSER LANE
MATAWAN, NJ 07747

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/10/2016 2/17/2017
PATEL, RITA (RPH)
4 HAUSER LANE
MATAWAN, NJ 07747

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/19/2017
PATEL, SANJAY (RPH)
16 SPLIT ROCK ROAD
UPPER SADDLE RIVER, NJ 07458

NPI-1316335961
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/26/2016
PATEL, SANJAY I. (RPH)
63 HEATHERDELL ROAD
ARDSLEY, NY 10502

NPI-1316335961
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2006
PATEL, SHIRJAY (CHHA)
703 NEW DOVER ROAD
EDISON, NJ 08820

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
PATEL, VIJAY
65 W. LINCOLN AVENUE
ROCKAWAY, NJ 07866

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2016
PATEL, VITTHAL I. (RPH)
ST. GEORGE AVE, APT. 141
AVENEL, NJ 07001

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2004 Permanent
PATHAK, VINEETA (MD)
533 LEAWOOD AVENUE
TOMS RIVER, NJ 08755

NPI-1104922939
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/29/2019
PATHARKAR, MANOJ (MD)
16 LINDA COURT
LAURENCE HARBOR, NJ 08879

NPI-1598808339
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/19/2016 Permanent
PATIN, YURY (MD)
45 BEVERLY ROAD
SUMMIT, NJ 07901

NPI-1548325400
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/26/2009
Elevator Medic Corporation
55 Brookview Drive
Woodcliff Lake, NJ 07677

Patrick DellAquila, President
55 Brookview Drive
Woodcliff Lake, NJ 07677

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/25/2014 02/24/2017
Ideal Elevator ServicesPatrick Dell'Aquila
55 Brookview Dr
Woodcliff Lake, NJ 07677

Patrick Dell'Aquila, President
55 Brookview Drive
Woodcliff Lake, NJ 07677

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/25/2014 02/24/2017
PATTERSON JR., ARTHUR (DC)
8 FELLOWWOOD WAY
HOLMDEL, NJ 07733

NPI-1164628822
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2014
PATTERSON, KELEE (RN)
577 EAST ROAD
BELFORD, NJ 07718

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
PATTI, JAMES OWNER
2700 HAMILTON BLVD. #169
S. PLAINFIELD, NJ 07080

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
Paul F. Roscitt Electric, Inc.
262 Harmon Ave
Fort Lee, NJ 07024

Paul F Roscitt, President
262 Harmon Ave
Fort Lee, NJ 07024

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/9/2015 11/08/2018
Area Fuel
207 Butler Ave
Staten Island, NY 10307

Paul Grillo, Owner
207 Butler Ave
Staten Island, NY 10307

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/18/2015 02/17/2018
Paul Sexton
462 10 th Ave
Paterson, NJ 07510

Paul Sexton, Owner
462 10th Ave
Paterson, NJ 07510

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/11/2014 07/10/2017
PAUL, DAVID M. (MD)
434 RAHWAY AVENUE
WOODBRIDGE, NJ 07095

NPI-1124355250
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/22/2002
PAYANO, VIANNE AKA AMPARO, VIANNE (CHHA)
710 EAST 18TH STREET
PATERSON, NJ 07501

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/31/2017
PEACOCK, DENISE (RN)
9331 GLENLOCH STREET
PHILADELPHIA, PA 19114

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PEARSON, KATIE (LPN)
229 SNOOKS HILL RD.
LEWISTOWN, PA 17044

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PEARSON, SHAMERA (CHHA)
2824 N. BAMBREY STREET
PHILADELPHIA, PA 19132

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/16/2019 Permanent
PEART, HAROLD (LCSW)
3 HARRISON PARK LANE
BURLINGTON, NJ 08016

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/17/2000
PEART, HAROLD (LCSW)
415 KEIM BOULEVARD
BURLINGTON, NJ 08016

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/1999

MARVIN PECK'S PHARMACY
335 GEORGE STREET
NEW BRUNSWICK, NJ 08901

PECK, MARVIN (RPH)
335 GEORGE STREET
NEW BRUNSWICK, NJ 08901

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
PELLEGRINO, TAMMY (RN)
2423 SHADY LANE APT P
ATCO, NJ 08004

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2003
PELLICANO, PAUL J. (MD)
120 MILLBURN AVE. STE M1
MILLBURN, NJ 07041

NPI-1316282783
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1998 Permanent
PEMBERTON, COLIN (MD)
500 ORANGE STREET
NEWARK, NJ 07107

NPI-1891935557
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/28/2017 4/26/2018
PEMBERTON, COLIN (MD)
2 DEVONSHIRE TERRACE
WEST ORANGE, NJ 07052

NPI-1891935557
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/8/2019
PENA, CARMEN F. (DDS)
800 76TH ST., 2ND FLOOR
NORTH BERGEN, NJ 07047

NPI-1871750166
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2000 9/15/2015
NICK PENACHIO CO., INC.
240 FOOD CENTER DRIVE
BRONX, NY 10474

PENACHIO, NICHOLAS A.
240 FOOD CENTER DRIVE
BRONX, NY 10474

NPI-

Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000
PENALES, AMANDO D.
BAYSIDE PRISON PO BOX F-1
LEESBURG, NJ 08327

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/9/2014
PENALVER, FAITH (RN)
4 MAPLE COURT
ROOSEVELT, NJ 08555

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
PENFIELD, JOHN (DO)
25 POCONO ROAD
DENVILLE, NJ 07834

NPI-1528078839
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2014 3/2/2018
PENFIELD, JOHN (DO)
25 POCONO ROAD
DENVILLE, NJ 07834

NPI-1528078839
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015 3/2/2018
PENICO, PETER (MD)
300 MAIN STREET
MILLVILLE, NJ 08332

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/24/1978 DECEASED
PENNANT GRAY, SONIA (CHHA)
491 PARK AVENUE
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/26/2019 Permanent
PENQUE, NICOLA
4 CAMELOT AVENUE
MONROE, NJ 08831

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/23/2015 11/22/2018
PEPE, ANTHONY
111 E. MIAMI AVENUE
CHERRY HILL, NJ 08034

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/1/2019
PERERA, SANTUSHT (MD)
7 GREENHILL ROAD
KINNELON, NJ 07405

NPI-1942311147
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/22/2016 Permanent
PEREZ, JORGE (MD)
213 14TH STREET
PALISADES PARK, NJ 07650

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/18/2004
PEREZ, JUANA (CHHA)
510 25TH STREET
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
PERLMAN, BERNARD (MD)
42 OAKMONT ROAD
YARMOUTH PORT, MA 02675

NPI-1477579456
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/3/2000 9/12/2017
PERRIN, DOUGLAS M. (CHHA)
1801 LAURAL ROAD
LINDERWOLD, NJ 08021

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2002
PERRY, ELSWETTA (CHHA)
291 NORTH PARK STREET, 1ST FLOOR
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/12/2018
PESCIOTTA, BARBARA ANN (RPH)
992 VAUGHN AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/18/2006
PESCIOTTA, ROY THOMAS (RPH)
992 VAUGHN AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/18/2006
Metroplex Products Co. Inc.
164 South Moetz Drive
Milltown, NJ 08850

Peter Herring, President
377 Deans Rhode Hall Rd
Monroe, NJ 08831

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/7/2015 01/06/2018
Peter Vincent
129 Highland Ave
Jersey City, NJ 07306

Peter Vincent, Owner
129 Highland Ave
Jersey City, NJ 07306

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/27/2015 04/26/2018
PETERS, MEAGHAN (RN)
707 BUCHANAN STREET, APT. 2
TOMS RIVER, NJ 08753

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/29/2019
PETERSON, PETHINA (CHHA)
289 MLK DRIVE
JERSEY CITY, NJ 07305

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
PETIT, MADELINE (CNA)
228 70TH STREET 2ND FL.
GUTTENBERG, NJ 07093

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/7/2008
PETRUCELLI, SALVATORE (MD)
201 LYONS AVENUE
NEWARK, NJ 07112

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/2/2000 Permanent
PETTERSON, LINDA A. (RN)
700 PARK BLVD.
CHERRY HILL, NJ 08002

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
PFAUTZ, JOANNA (LPN)
1595 BREAKERS DRIVE, #A
MANAHAWKIN, NJ 08050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2018
PFLUGER, FRANK
118 MINERVA AVENUE
ALBION, NJ 08009

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

8/27/2001
PHARES, ALYSSA (RN)
21 WOODLAND WAY
DAYTON, NJ 08810

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2002
PHILEMON, MENAHEM (CHHA)
265 KING VILLAGE
BUDD LAKE, NJ 07869

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2018
PHILIPPE, ADELINE (CHHA)
61 CLEVELAND STREET, APT. 2E
ORANGE, NJ 07050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/12/2018
PHILIPPE, IRLANDE (RN)
29 ELM STREET
WEST ORANGE, NJ 07052

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017
PHILLIPS, RONALD (DO)
718 HAVEN PLACE
LINDEN, NJ 07026

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/8/1999 Permanent
PHIPPS JR., ERNEST (MD)
130 FORD ROAD
HOWELL, NJ 07731

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
PIACENTILE, JOSEPH (MD)
578 BIG OAK ROAD
YARDLEY, PA 19067

NPI-1265607410
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/17/1995 Permanent
PIAZZA, GARY G. (DO)
7 CARRIAGE PLACE
EDISON, NJ 08820

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/1998 Permanent
PICARIELLO, JOSEPH
1202 FOX CHASE LANE
WHIPPANY, NJ 08981

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/9/2000 6/1/2016
PICKNEY, BRANSON, OWNER
408 W. 129TH ST., APT. 7
NEW YORK, NY 10027

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
PIERCE, JACQUELINE (CHHA)
1066 NORTH 28TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/14/2017
PIERCE, LESLIE (CHHA)
511 1ST AVENUE, APT. #3-W
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/6/2018
PIERRE, OTILIEN (CHHA)
454 SOUTH OLDEN AVENUE
TRENTON, NJ 08609

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
PIERSON, GEORGE T. (DO)
5 RAINBOW TRAIL
SPARTA, NJ 07871

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

4/2/1988 DECEASED
PIMPONG, SWANZELLA (RN/LPN/CHHA)
14 3RD STREET, FLOOR 1
NEWARK, NJ 07107

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/3/2017
PINEDA, FRANCISCA
151 TRAILS END
NEW CITY, NY 10956

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
PINHO, FERNANDO F.
66 6TH AVENUE
LONG BRANCH, NJ 07740

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/30/2012 7/29/2015
PINKERTON, MARION (LPN)
410 THOMAS AVENUE
RIVERTON, NJ 08077

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/19/2003
PINNAMARAJU, VENKATA (RPH)
5324 FOX RIDGE ROAD
ROANOKE, VA 24018

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/2017
PIOTROWSKI, DENISE (CHHA)
100 EAST MAIN STREET
MARLTON, NJ 08053

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/31/2017
PIRLAMARLA, JYOTI (MD)
77 JACKSON MILLS ROAD
FREEHOLD, NJ 07728

NPI-1952349425
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/21/2016
PIRMISASHVILLI (CHHA)
43 LINDEN STREET
FORDS, NJ 08863

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
PIROVOLAS, NICHOLAS (RPH)
30 DWIGHT DRIVE
WEST DEAL, NJ 07712

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/16/2000
PIROVOLOS, NICHOLAS (RPH)
30 DWIGHT DRIVE
OCEAN, NJ 07712

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
PISANI, LOUIS (RPH)
2 E. FRANKLIN COURT
GARDEN CITY, NY 11530

NPI-1215250709
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2000
PISANI, LOUIS (RPH)
PO BOX 737513
ELMHURST, NY 11373

NPI-1215250709
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
PIUCK, CHARLOTTE L. (MD)
593 RAMAPO VALLEY ROAD
OAKLAND, NJ 07436

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/25/2001 Permanent
PIZZARELLI, ANGELA D.
1111 BOND STREET
ASBURY PARK, NJ 07712

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
PLANT, CHINIA
2013 LOGAN STREET
HARRISBURG, PA 17102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
PLINIO, STEVEN (DC)
655 AMBOY AVENUE
WOODBRIDGE, NJ 07095

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/30/1999 DECEASED
PLOTNIK, PETER J. (MD)
276 COLERIDGE STREET
BROOKLYN, NY 11235

NPI-1407019813
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/23/2000 Permanent
PLOTTS, LISA AKA FROSCH, LISA (RN)
111 BEECHWOOD AVENUE
OAKLYN, NJ 08107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
PLUCINSKI, PATRICIA (LPN)
201 HAEGELE PLACE
MOUNT ROYAL, NJ 08061

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2009 Permanent
POBER, JOSEPH (MD)
126 LINDEN STREET
RIDGEWOOD, NJ 07450

NPI-1194948703
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/14/2019
POET, ALBERT (MD)
EAST BAY AVENUE
MANAHAWKIN, NJ 08050

NPI-1134270903
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
POFF, SHIABON (LPN)
48 CHESTNUT STREET
WARETOWN, NJ 08758

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/22/2017
POGGIOLI, STEPHAN
431 ACADEMY TERRACE
LINDEN, NJ 07036

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/18/2004
SUN REHAB, INC.
BILLINGS AVENUE, APT. 619A
PAULSBORO, NJ 08062

POH-EIKOM, VICKI
BILLINGS AVE., APT. 619A
PAULSBORO, NJ 08062

NPI-

Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/11/2000 Permanent
POH-EIKOM, VICKI
BILLINGS AVE., APT. 619A
PAULSBORO, NJ 08062

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/29/1999 Permanent
POLANSKY, IRVING (RPH)
260 MAIN ST
KEANSBURG, NJ 07734

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/9/1985 Permanent
POLISE, VINCENZO (RPH)
33 HARRISON ROAD
KINNELON, NJ 07405

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/31/2015
POLISHUK, ANDRIJ A.
649 PULHAM COURT #A
MANCHESTER, NJ 08759

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/8/2008
POLLACK, EARL T. (DMD)
171 N. LANSDOWNE AVE.
LANSDOWNE, PA 19050

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/7/1986 Permanent
POLLACK, JOSEPH (DPM)
P. O. BOX 11401
YARDVILLE, NJ 08628

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/1982 9/30/1987
POLLEN, PHILIP
245 ROUTE 9
MORGANVILLE, NJ 07751

NPI-1245341924
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/28/2013
V. PONTE & SONS, INC.
511 CANAL STREET
NEW YORK, NY 10013

PONTE, ANGELO J.
511 CANAL STREET
NEW YORK, NY 10013

NPI-

Vendor
Organized Crime Control Act
Suspension

Treasury
Treasury Purchase Bureau

1/9/1996
PONTE, ANGELO J.
111 PATERSON AVENUE
HOBOKEN, NJ 07030

NPI-
Vendor
Organized Crime Control Act
Suspension

Treasury
Treasury Purchase Bureau

1/9/1996
POOLE, JAMES (RN)
34 SOUTH 2ND STREET, APT. 5
DEQUESNE, PA 15110

NPI-1639367972
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
POOLE, KENDRA (CHHA)
222 COOLIDGE AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
POPICK, ALAN (DO)
1532 CREEKSIDE ROAD
WHITEHALL, PA 18052

NPI-1194789214
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
POROGER, EMMA (DO)
59 LINWOOD ROAD
STATEN ISLAND, NY 10308

NPI-1669572368
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
PORTNOY, BARRY
1300 INDUSTRIAL BLVD #5
SOUTHAMPTON, PA 18966

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/30/2012 1/29/2015
POSNER, ROBERT S. (DDS)
53 WESTFIELD AVENUE
CLARK, NJ 07066

NPI-1740518992
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/23/1999 Permanent
POTACCO, PHILIP (DC)
54 CHURCH STREET
SOUTH ORANGE, NJ 07079

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2003
POTTER, DIANE (LPN)
215 FAIRFIELD LANE
KING WILLIAM, VA 23086

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2009
POWELL, WILLIE (MFT)
2130 MILLBURN AVENUE
MAPLEWOOD, NJ 07040

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016 Permanent
POWLETT, NORMAN, OWNER
133 MILL STREET, 2R
MT. HOLLY, NJ 08060

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/29/2011 12/28/2014
PRAVETZ, MICHAEL (MD)
531 GATES STREET
PHILADELPHIA, PA 19128

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/5/2001 Permanent
PRENSKY, JOSHUA (DMD)
28-10 HIGH STREET
FAIRLAWN, NJ 07410

NPI-1578761961
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/17/2009
PRENSKY, JOSHUA (DMD)
2810 HIGH ST.
BERGEN, NJ 07410

NPI-1578761961
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/29/2013
PRESILLA, ALEJANDRO (MD)
15 FULTON STREET
WEEHAWKEN, NJ 07086

NPI-1902835747
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/30/2010 4/30/2013
PRESS, STUART M. (MD)
1525 E. PUTNAM AVE #206
OLD GREENWICH, CT 06870

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/1/2009
PRINTZ, BRUCE I. (DO)
400 GILL LANE
ISELIN, NJ 08830

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/6/2004
PRITCHARD, JOSEPH
69 TALLWOOD DRIVE
MEDFORD, NJ

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/9/2002 12/10/2014
CUSTOM SHOE SERVICE
218 HALSEY STREET
NEWARK, NJ 07102

PROSKUROVSKY, BORIS
218 HALSEY STREET
NEWARK, NJ 07102

NPI-

Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/25/1998
CUSTOM SHOE SERVICE
218 HALSEY STREET
NEWARK, NJ 07102

PROSKUROVSKY, BORIS
218 HALSEY STREET
NEWARK, NJ 07102

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/4/1997 Permanent
PROTAS, OLEG (CHHA)
407 LIBERTY LANE
MARLTON, NJ 08053

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/26/2017
PROVOST, LAURIE (LPN)
10 BALTIMORE BLVD
SEA GIRT, NJ 08750

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

1/24/2014
PRZADOWSKA-KOKINDA, ELIZABETH M. (RN)
1106 PARKSIDE AVENUE
TRENTON, NJ 08618

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2005
PUCCI, BRIAN M. (RPH)
14 RAND RD.
PINE BROOK, NJ 07058

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2005 9/19/2014
PUENTES, ELENA (CHHA)
374B HAMILTON STREET
SOMERSET, NJ 08873

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/2007
PUGLIESE, GIROLAMO (MD)
103 MAIN STREET
KEYPORT, NJ 07735

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/22/1999 DECEASED
PUIG, TAYLOR (CHHA)
21 OVERVIEW COURT, APT. 21
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/16/2021
PUIG, TAYLOR (PHARM TECH)
21 OVERVIEW COURT, APT. 21
BAYVILLE, NJ 08721

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/23/2021
PULVIRENTI, FRANCESCA M.
212 8TH STREET
SURF CITY, NJ 08008

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/29/2005
PURNESS, TIFFANY (CHHA)
105 BLACKWOOD-CLEMONTON ROAD #704
LINDENWOLD, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/26/2018
QAYYUM, ABDUL (RPH)
960 COUNTRY CLUB DRIVE
TEANECK, NJ 07666

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/27/2000 Permanent
QUARTARARO, LOUIS (MD)
37 WEST CENTURY ROAD
PARAMUS, NJ 07652

NPI-1467460089
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/5/2019
QUEEN, RYSHAUN (CHHA)
6 KINGSBURY SQUARE, APT. #1-D
TRENTON, NJ 08611

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2018
QUEST, BRITTANY (CHHA)
379 SANFORD AVENUE
NEWARK, NJ 07106

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
QUIJADA, CARLOS (COUNSELOR)
106 SPRING VALLEY AVE, #1
HACKENSACK, NJ 07601

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/20/2012 4/9/2019
QUINN, JOHN C. (RN)
437 HARRISTOWN ROAD
GLEN ROCK, NJ 07452

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2006
QUINONES, ANEL
48 GRAND STREET
GARFIELD, NJ 07026

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/11/2001 Permanent
QUINONES, ELIZABETH (CHHA)
210 BOND STREET
ELIZABETH, NJ 07206

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
QURESHI, SHAMS (MD)
1084 MAIN AVENUE
CLIFTON, NJ 07011

NPI-1194743377
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

1/27/2012
RAAB, TERRI A. (LPN)
3 MILL ROAD
JAMESBURG, NJ 08831

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2004
RABAH, MOHAMMAD (DMD)
55 ENCLOSURE STREET
NUTLEY, NJ 07110

NPI-1669684114
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/3/2017 8/23/2019
RAC, EDWARD P.
109 BERNARD DRIVE
MANAHAWKIN, NJ 08050

NPI-
Professional
Industry Law Violation
Disqualification

Treasury
Treasury Purchase Bureau

10/12/2004
Rachel Frasca, Owner
326 Coles Mill Road
Williamstown, NJ 08094

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/7/2014 1/6/2017
RADICS JR., ALEXANDER (LPN)
13 WHITE HAVEN PLACE
BLOOMINGDALE , NJ 07403

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/2019 Permanent
RADOWITZ, MARK A. (DC)
76 CHICHESTER ROAD
MONROE TOWNSHIP, NJ 08831

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/2007
Everest Masonry Construction, Inc.
129 Cantello Street
Union City, NJ 07087

Rafael Ramos, President
163 E. Main Street Suite 311
Little Falls, NJ 07424

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/9/2015 11/08/2018
RAFLA, MAGDY
3 KULESSA COURT
EAST BRUNSWICK, NJ 08816

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/22/2011
RAHMAN, RONALD (MD)
20 SUSSEX AVENUE
VOORHEES, NJ 08043

NPI-1437378502
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/29/2013
RAHMAN, SAHID (CHHA)
29 ROBIN COURT
PISCATAWAY, NJ 08854

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018
RAIA, JOSEPH (MD)
56 GRAFTON AVENUE
NEWARK, NJ 07104

NPI-1225126717
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/28/2014
RAINFORD, JOHN, CHAIRMAN
239 CLIFTWOOD ROAD
OAKHURST, NJ 07755

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/1/2012 1/29/2015
RAJA, ABDUL, H.
53 FULHAN LANE
HOLBROOK, NY 00741

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2003 Permanent
RAJU, SRINIVASA (RPH)
115 RIVERWALK WAY D2
CLIFTON , NJ 07014

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017
RAMACHANDRA, NANDAVAR (MD)
741 ROUTE 18 S.
EAST BRUNSWICK, NJ 08816

NPI-1235219809
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/18/2014 11/5/2018
RAMACHANDRA, NANDAVAR (MD)
165 SALEM ROAD
NORTH BRUNSWICK, NJ 08902

NPI-1235219809
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/21/2020
RAMANADHAM, ARUNA R. (MD)
9 MOUNTAINVIEW DRIVE
LIVINGSTON, NJ 07039

NPI-1609157692
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/12/2000 Permanent
RAMAS, EDWIN L. (LPN)
789 MITCHEL AVE.
UNION, NJ 07083

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

7/17/2009 7/17/2014
RAMIREZ, MARIELA (CHHA)
775 EAST 3RD AVENUE, APT. A
ROSELLE , NJ 07203

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/9/2018
RAMOS, JEANETTE (CHHA)
234 WILMONT AVENUE
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
RAMOS, REYNALDO
52 ABINGTON CT.
MAYS LANDING, NJ 08330

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

8/12/2013
RAMOS, ROLANDO
85 SHERMAN AVENUE
TEANECK, NJ 07666

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2004
RAMPERSAD, LAKSHMINARINE
11 APPLETREE LANE
LANDING, NJ 07850

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2000
RAND, DOV (MD)
667 EAGLE ROCK AVENUE
WEST ORANGE, NJ 07052

NPI-1043311145
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/15/2012
RAND, DOV (MD)
667 EAGLE ROCK AVENUE
WEST ORANGE, NJ 07052

NPI-1043311145
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

9/3/2013
RAND, DOV (MD)
840 STONEWALL CT G
FRANKLIN LANES, NJ 07417

NPI-1043311145
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

5/7/2014
RAND, ELIAS
1401 OCEAN AVENUE
BROOKLYN, NY 11230

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
JD Scaffold Inc.
13353 NE 17th Ave
North Miami, FL 33181

Randy Garciga, Owner
13353 NE 17th Ave
North Miami, FL 33181

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

8/25/2014 08/24/2017
JTG Scaffolding & Hoisting LLC
13353 NE 17th Ave
Miami, FL 33181

Randy Garciga, Owner
309 West Elizabeth Avenue
Linden, NJ 07036

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/23/2014 10/22/2017
RAO, MALINI (MD)
444 WASHINGTON BOULEVARD
JERSEY CITY, NJ 07310

NPI-1649456005
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
RASCHID, SOHAEL (MD)
1126 KENNEBEC DRIVE
CHAMBERSBURG, PA 17201

NPI-1104851369
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
RASNER, STEVEN (DMD)
1055 NORTH PEARL ST
BRIDGETON, NJ 08401

NPI-1114022803
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/16/1984 4/5/2018
RASOULINEJAD, ZEHRAH T. (DDS)
P.O. BOX1217
ALPINE, NJ 07620

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2003
RATCHFORD, WILLIAM B. (MD)
PO BOX 2063
GLENVIEW, IL 60025

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

6/4/1998
RAUH-BRIGHAM, SUSAN (RN)
4 BRECKENRIDGE DRIVE
SHAMONG, NJ 08088

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
RAVAL, KAWU
600 PAVONIA AVENUE
JERSEY CITY, NJ 07306

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/1/1998
RAVIN, JOHN M. (MD)
9600 STERLING RIDGE AVE.
LAS VEGAS, NV 89129

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
RAY, DEBRA (RN)
32 KAYWIN AVENUE
HAWTHORNE, NJ 07506

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
Van Peenen Landscape Contractors, Inc.Van Peenen Landscape Contractors, Inc.
3 Gates Place
Wayne, NJ 07470

Raymond Van Peenen, President
555 Preakness Ave Suite 210
Totowa, NJ 07512

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/23/2015 11/22/2018
RAYNOR, MARCELLA
660 BROAD STREET, APT. 811
HARRISBURG, PA 17102

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
RAZIQ, RAFIK
NORTHERN STATE PRISON
NEWARK, NJ 07115

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/1/2002 Permanent
REA, MICHAEL (MD)
444 MANSFIELD AVENUE
HADDONFIELD, NJ 08033

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/11/2001 DECEASED
REATH, ERIN R. (RN)
7705 SABRE DRIVE
KNOXVILLE, TN 37919

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/18/2005
REAVES, LORI A. (MD)
FPC ALDERSON - GLEN RAY RD
ALDERSON, WV 24910

NPI-1417959503
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/7/2014
REBA, GARY J. (DDS)
TITUS LANE
PLAINSBORO, NJ 08536

NPI-1285852541
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2007
Rebecca Adika, Secretary

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

7/21/2014 7/20/2017
RECK, FRANZ (DMD)
17 CENTER STREET
HIGHLANDS, NJ 07732

NPI-1528248457
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/2019 7/21/2020
REDDEN, DAYJA (CHHA)
1822 SOUTH 7TH STREET
CAMDEN, NJ 08104

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
REDDY, PRANATHI (DMD)
6207 SPRUCE MILL DRIVE
MORRISVILLE, PA 19067

NPI-1538321583
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2019 7/21/2020
REDNOR, GERALD B.
101 KENSINGTON AVENUE
TRENTON, NJ 08618

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
REDONDO, ILEANA (MD)
2421 ROSETTE STREET
FORT LEE, NJ 07024

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/23/2002 Permanent
REED, DAVID, PRESIDENT
195 AIRPORT ROAD
SELINGSGROVE, PA 17870

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/14/2013 1/13/2016
REED, JUDY
233A MUHAMMAD ALI AVE
NEWARK, NJ 07108

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/15/2005
REED, STEPHAN NILS (DC)
4722 EAST DELL RD
PHOENIX, AZ 85026

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
REEVES, WILBURN C.
CREEK ROAD
BRICK, NJ 08724

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
REEVES,THOMAS
1145 DRAGSTON ROAD, PO BOX 528
PORT NORRIS, NJ 08349

NPI-
Professional
Industry Law Violation
Debarment

Treasury
Treasury Purchase Bureau

2/28/2017 2/28/2020
REEVES,TODD
1474 WEST MAIN ST., PO BOX 427
PORT NORRIS, NJ 08349

NPI-
Professional
Industry Law Violation
Debarment

Treasury
Treasury Purchase Bureau

2/28/2017 2/28/2020
REGO, RAMON (MD)
6701 BERGENLINE AVENUE
WEST NEW YORK, NJ 07093

NPI-1033227459
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/19/2012 2/16/2017
REHAN, ZAHEER, A.
280 HENDERSON STREET
JERSEY CITY, NJ 07302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/10/1999 Permanent
REHMAN, FAROOQ (MD)
225 MAY STREET, SUITE D
EDISON, NJ 08837

NPI-1467581827
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/20/2016 2/9/2017
REHMAN, FAROOQ (MD)
225 MAY STREET, SUITE D
EDISON, NJ 08837

NPI-1467581827
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/13/2015
REID, PEACHES (CNA)
11 RUTGERS STREET
IRVINGTON, NJ 07111

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/1/2002
REINHARD, BARBARA
704 REED COURT
FLEMINGTON, NJ 08822

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/9/2007
REINHART, JENNIFER (LPN)
70 ROSS AVENUE
HACKENSACK, NJ 07601

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/23/2019
REITER, RAYMOND D. (MD)
405 MURRAY HILL PKWY#1023
E. RUTHERFORD, NJ 07073

NPI-1841447380
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/22/2001 Permanent
RENNER, ALLISON
1210 OAK ROAD
MANASQUAN, NJ 08736

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
RENNER, CARL (MD)
61 WALDRON AVENUE
GLEN ROCK, NJ 07452

NPI-1346205705
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/25/2019 Permanent
RENZI, CAROLINE M. (DO)
247 CENTER ST
TRENTON, NJ 08611

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

12/4/1991 Permanent
REVAN-LEWIS, CHAUNDREL (CHHA)
26 NANCY LANE
PISCATAWAY, NJ 08854

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
REYES, BRIANNA (CHHA)
220 WEST BRANCH AVENUE, APT. 111
PINE HILL, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2019
REYES, DANNIELL (DC)
5262 HAMILTON S
SAYLORSBURG, PA 18353

NPI-1124053905
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
REYES, MARIA (CHHA)
1207 ATLANTIC AVENUE
CAMDEN, NJ 08104

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/29/2017
REYES-ARIAS, ARCADIO
286 SUSSEX AVENUE
NEWARK, NJ 07107

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
REZNIKOVA, YELENA (CHHA)
73 MADISON GARDENS
OLD BRIDGE, NJ 08857

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/12/2017
RHODES, SARE MAE (DMD)
161 BRIDGE STREET
TUNKHANNOCK, PA 18657

NPI-1750572996
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
RIACHI, LABIB (MD)
128 SOUTH EUCLID AVENUE
WESTFIELD, NJ 07090

NPI-1801846597
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/9/2017
RIACHI, LABIB (MD)
42 RUTGERS AVENUE
COLONIA, NJ 07067

NPI-1801846597
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/9/2018
RICCIARDI, JUDE (CHHA)
1452 45TH
NORTH BERGEN, NJ 07047

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2002
RICCIO, PETER (RPH)
17 CASALE DRIAVE, APT R2
WARREN, NJ 07059

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
RICH, LEO
CEDAR LANE
TEANECK, NJ 07666

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
Apex Tower Services, Inc.
245 Sharp Road
Marlton, NJ 08053

Richard Pluese, Vice-President
66 E Cedar Avenue
Marlton, NJ 08053

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/10/2016 02/09/2019
RICHARDS, AARON (COUNSELOR)
23 WYCOFF STREET
DEAL, NJ 07723

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2001
RICHARDSON, RUTH (CHHA)
555 E. 27TH STREET, APT. 11
PATERSON, NJ 07514

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/22/2019
RICHARDSON, YALONDA (CHHA)
52 2ND AVENUE
TOMS RIVER, NJ 08757

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/20/2017
RICHLINE, AMANNDA (DPM)
4 GREENWICH STREET
BELVIDERE, NJ 07823

NPI-1013040435
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/22/2017
RICHMAN, HOWARD P. (DPM)
502 N BLACK HORSE PIKE
WILLIAMSTOWN, NJ 08053

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/15/1993 Permanent
RICHSTONE, GEOFFREY (MD)
PO BOX 38, FCI
FORT DIX, NJ 08640

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2002
RIGGI, JOSEPH (MD)
36 VARDON WAY
FARMINGDALE, NJ 07727

NPI-1265436638
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/9/2015 4/9/2019
RIGO, BLADIMIR
FCI-FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/12/2016
RILEY, BRIDGETT (PHARM TECH)
1801 EGG HARBOR ROAD
LINDENWALD, NJ 08021

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2003
RIMERMAN, VALERY (MD)
43 DEMAREST AVENUE
CLOSTER, NJ 07624

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006 DECEASED
RIOS, GUSTAVO ERNESTO (MD)
127 TWEED DRIVE
JACKSONVILLE, NC 28540

NPI-1780648295
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/11/2011
RIOS, JOSE (MD)
175 SUMMER AVENUE
NEWARK, NJ 07104

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/1998 Permanent
RIPPS, DANIEL (DDS)
1330 CALHOUN STREET
TRENTON, NJ

NPI-1124293659
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1995 Permanent
RIVERA, DAISY (CHHA)
329 LINE STREET
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/29/2018
RIVERA, HECTOR RICHARD
1 KEVIN ROAD
SCOTCH PLAINS, NJ 07076

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/9/2012 1/8/2015
RIVERA, JACQUELINE (CHHA)
418 12TH STREET, APT. #1
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/23/2018
RIVERA, JOSSELIN
251 MT. VERNON ST.
CAMDEN, NJ 08103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/27/2006
RIVERA, KAREN (CHHA)
209 NILES STREET, APT. 1
ELIZABETH, NJ 07202

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

2/20/2017
RIVERA, MARIA (RN)
39 JOHNS WAY
BRIDGETON, NJ 08302

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2019
RIVERA, NICOLE AKA CRESTA, NICOLE (RN)
2009 KICKAPOO TERRACE
VINELAND, NJ 08361

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2017
RIVERA, VIVIANIS (CHHA)
519 BRUNSWICK AVENUE
TRENTON, NJ 08638

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/20/2017
RIZVI, SAIYID (PHD)
100 CRAIG ROAD, SUITE 104
MANALAPAN, NJ 07726

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/18/1997
Rizzo New York Inc.Rizzo New York Inc.
9157 97th St
Wood Haven, NY 11421

Rizwan Ahmad, President
109-02 Jamaica Avenue
Richmond Hill, NY 11418

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/20/2016 01/19/2019
RIZZO, KENNETH (RPH)
110 WELLS FARM ROAD
GOSHEN, NY 10924

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/19/2005
RIZZUTO, MARY F. (LCSW)
16 HOLLY DRIVE
TOMS RIVER, NJ 08753

NPI-1851499891
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/22/2012
ROBACK, MARY (LPN)
2517 DUNKSFERRY ROAD, APT. L203
BENSALEM, PA 19020

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2018
ROBALINO, JOFFRE (MD)
PO BOX 1000
CUMBERLAND, MD 21501

NPI-1770634404
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/28/2013
ROBBERSON JR., KENNETH
3404 SHORELINE DRIVE
WALL TOWNSHIP, NJ 07719

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/16/2017
ROBBINS, GORDON J.
447 UNION AVENUE
PATERSON, NJ 07522

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/30/1987 Permanent
ROBBINS, RICHARD G. (MD)
551 MILLBURN ACE.
SHORT HILLS, NJ 07078

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/19/2004
Robert M. Mesmer, LLC
24 Sand Bridge Rd.
Elmer, NJ 08318

Robert Mesmer, Managing Member
24 Sand Bridge Road
Elmer, NJ 08318

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/12/2014 12/11/2017
ROBERT, ELIANE (CHHA)
380 PARK AVENUE, APT. C5
ORANGE, NJ 07050

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
ROBERTS, JAMES (RN)
235 PENN AVENUE
DOVER, NJ 07801

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2017
ROBERTSON, TANAYE (CHHA)
1200 EAST STATE STREET, APT. 1405
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2018
ROBINSON, CHRISTINA (CHHA)
81 ABBLETT VILLAGE
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/22/2019
ROBINSON, KIM
594 WALNUT STREET
ELIZABETH, NJ 07201

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/3/2003
ROBINSON, TRENNAJIA (CHHA)
89 FOURTH STREET, APT. #43
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2017
ROBINSON, VINCENT
62 MAPLE AVE.
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

3/13/2009 3/13/2014
ROBINSON, WANDA
150 MELROSE AVE.
IRVINGTON, NJ 07111

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/4/1986 Permanent
RODENBERG, THOMAS (MD)
DESOTO ANNEX, 13617 SOUTHEAST HWY 70
ARCADIA, FL 34266

NPI-1720280183
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2015
RODRIGUEZ, ARACELY (CHHA)
1039 NORTH 35TH STREET
CAMDEN, NJ 8105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/31/2018
RODRIGUEZ, BEATRIZ
109 GREENBRIAR AVE BOX157
RICHLAND, NJ 08350

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
RODRIGUEZ, CHRISTIAN (CHHA)
2 W. PARK AVENUE
PENNS GROVE, NJ 08069

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2019
RODRIGUEZ, DARIELI (CHHA)
545 NEWTON LAKE DRIVE
COLLINGSWOOD, NJ 08107

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/26/2017
RODriguez, Eddy
1100 W. 7th St., Apt. 9
Plainfield, NJ 07060

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

5/14/2015 5/13/2018
RODRIGUEZ, FERNANDO (MD)
122 S. MONTFORT DRIVE
BELLE MEAD, NJ 08502

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/6/2004
RODRIGUEZ, JAZMIN (CHHA)
214 48TH STREET
UNION CITY, NJ 07087

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2018
RODRIGUEZ, LEONELA (CHHA)
1032 N. 21ST STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/10/2018
RODRIGUEZ, MELENYS (CHHA)
18 WINDING WOOD DRIVE
SAYREVILLE, NJ 08872

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/29/2017
RODRIGUEZ, NICOLE (CHHA)
658 DELSEA DRIVE
PITMAN, NJ 08071

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/6/2018
RODRIGUEZ, RAMON R.
100 MANHATTAN AVENUE
JERSEY CITY, NJ 07307

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/17/1986 DECEASED
RODRIGUEZ, RONALD (LPN)
7 EASTERN LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2006
RODRIGUEZ, RONALD (LPN)
7 EASTERN LANE
WILLINGBORO, NJ 08046

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/11/2018
ROGERS, JAMES G.
49 WESTERN PARKWAY
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

4/11/2006 Permanent
ROHAUS, ROBERT (LAB. EMPL)
301 LILAC COURT
BRIDGEWATER, NJ 08807

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

8/25/2000
ROHE, PAUL (DPM)
24 FAIRWAY DRIVE
GREEN BROOK, NJ 08812

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
ROLON JR., ORLANDO
1239 DUPONT STREET
CAMDEN, NJ 08105

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/12/2009
ROMANAZZI, THOMAS
612 MYRTLE AVE
MANASQUAN, NJ 08786

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
ROMAN-CISSE, DENISE (PHARM TECH)
9 SECOND AVE
NEWARK, NJ 07104

NPI-
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

4/12/2012
ROMANOWSKI, STEVEN
PO BOX 1011
UNION, NJ 07083

NPI-
Medical
Poor Performance
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1985 Permanent
ROMERO, IVAN (RPH)
USP CANAAN - PO BOX 300
WAYMART, PA 18472

NPI-1003089343
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/8/2011
ROMILLO, JOSE (MD)
954 FISCHER BOULEVARD
TOMS RIVER, NJ 08753

NPI-1467544155
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/16/2011
RONAN, KATHLEEN (RN)
17 HENRY STREET
SAYERVILLE, NJ 08872

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
RONCAL JR., MARIO
901 RIFLE CAMP ROAD
WOODLAND PARK, NJ 07424

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/20/2014
RONE, FELICIA (CHHA)
2702 SHETLAND WAY
WESTVILLE, NJ 08093

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/14/2017
ROQUE, JOSE RAMON (MD)
317 60TH STREET
W. NEW YORK, NJ 07903

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/1/1996 Permanent
ROSA, EDDIE (MD)
796 MT. PROSPECT AVE
NEWARK, NJ 07104

NPI-1215045869
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

2/15/2012
ROSA, EDDIE (MD)
117-119 3RD AVE 2
NEWARK, NJ 07104

NPI-1215045869
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/26/2015
ROSA, EDDIE (MD)
796 MT. PROSPECT AVENUE
NEWARK, NJ 07104

NPI-1215045869
Medical
Antitrust/Anti-Kickback Acts
Debarment

Human Services
Medical Assistance (Medicaid)

11/21/2016
ROSA, EDDIE (MD)
796 MT. PROSPECT AVENUE
NEWARK, NJ 07104

NPI-1215045869
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/17/2013
ROSADO, EDITH (CHHA)
326 GREGORY AVENUE
PASSAIC, NJ 07055

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
ROSANIA, NICHOLAS G. (DC)
1 COBBLESTONE LANE
LONG VALLEY, NJ 07853

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2003
ROSARIO, JASON (CHHA)
133 RUTGERS PLACE
NUTLEY, NJ 07110

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/1/2017
ROSE, RADCLIFFE (RN/PHARM TECH)
99 GROVE AVENUE
MAYWOOD, NJ 07607

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/21/2018 Permanent
ROSEN, BURTON (DDS)
1939 ROUTE 70 EAST
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/24/1999 Permanent
ROSEN, JAY
3 HIDDEN ACRES DRIVE
VOORHEES, NJ 08043

NPI-1720139736
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/22/2016 Permanent
ROSENBERG, MARK (RN/APN)
19 BRANDYWINE DRIVE
MARLTON, NJ 08052

NPI-1407829096
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
ROSENBLIT, ERIN (RN/APN)
654 8TH STREET
ABSECON, NJ 08201

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/5/2018
ROSENFARB, ANDREW (ACUPUNCTURIST)
332 SOUTH AVENUE EAST
WESTFIELD, NJ 07090

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2005
ROSENSWEET, MARTIN (DPM)
FORT DIX FCI, PO 38
FORT DIX , NJ 08640

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/18/2002
ROSERO, BENITO (MD)
107 E. MANTUA AVENUE
WEHONAH, NJ 08090

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/2/1998
ROSERO, BENITO (MD)
109 AMBLER ROAD
CHERRY HILL, NJ 08002

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/6/1999
ROSPOS,THOMAS
6 INLET TERRACE
BELMAR, NJ 07719

NPI-
Vendor
Criminal Offense
Debarment

Law and Public Safety
1020

2/25/2016 2/25/2026
ROSS, BERNARD (MD)
30 E. PASSAIC STREET
MAYWOOD, NJ 07607

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/5/1999 Permanent
ROSS, CLAYTON
18 SOUTH TERRACE
MAYWOOD, NY 12524

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

12/2/2013 12/1/2016
ROSS, DOUGLAS AKA SHAW, RICKY
123 N 19TH STREET
EAST ORANGE, NJ 07017

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/14/2005
ROSS, JONATHAN (MD)
11 TEAK COURT
CHERRY HILL, NJ 08003

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/19/2000 Permanent
ROSS, JOSIE B. (RN)
25 GRAND AVE.
HACKENSACK, NJ 07601

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2004
ROSS, RUBY (LPN)
149 RIDGE AVENUE
ASBURY PARK, NJ 07712

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/5/2017
ROSSI, ANGELA (LPN)
813 HAZELTON AVENUE
LANOKA HARBOR, NJ 08734

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
ROSSNICK, GERALD (DDS)
868 BROADWAY
BAYONNE, NJ 07002

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

12/1/1988 Permanent
ROTHENBERG, HOWARD (DMD)
11 OAK SPRING ROAD
WEST NYACK, NY 10994

NPI-1437223898
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/2017
ROTHSTEIN, JEFFREY (DMD)
326 BROAD STREET, SUITE 1
RED BANK, NJ 07701

NPI-1366677544
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2017 9/22/2017
ROTWEIN, PAUL S. (DDS)
220 E. 63RD ST, APT 8F
NEW YORK, NY 10021

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/20/2003
ROUGH, JAMES
12767 VAN HORNE ROAD
MEADVILLE, PA 16335

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

3/22/2013 3/21/2016
ROUNTSEV, ANATOLI AKA ROUNTSEZ, TONY (CHHA)
406 RIVERVIEW DRIVE
TOTOWA, NJ 07512-

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
ROUNTSEV, ANATOLI AKA ROUNTSEZ, TONY (CHHA)
409 RIVERVIEW DRIVE
TOTOWA, NJ 07512

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

11/4/2014
ROUNTSEZ, ANATOLI AKA ROUNTSEV, TONY (CHHA)
409 RIVERVIEW DRIVE
TOTOWA, NJ 07512

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

11/4/2014
ROUNTSEZ, ANATOLI AKA ROUNTSEV, TONY (CHHA)
406 RIVERVIEW DRIVE
TOTOWA, NJ 07512-

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/11/2016
ROUSE, JODY (LPN)
189 BROWNIES RD.
SHIPPENVILLE, PA 16254

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
ROUSSIS, NICHOLAS (MD)
4735 HYLAN BOULEVARD
STATEN ISLAND, NY 10312

NPI-1497749089
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/1/2017
ROWE, ELIZABETH (LPN)
6 WINDING WOOD DRIVE, APT. 1B
SAYREVILLE, NJ 08872

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/28/2018
R & B Construction
2008 Carmel Road
Millville, NJ 08332

Roxanne Lloyd, President
2008 Carmel Road
Millville, NJ 08332

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/11/2015 06/10/2018
New Jersey State Flooring, Inc.
109 Greentree Road
Brick, NJ 08724

Roy C. Apgar, President
109 Greentree Road
Brick, NJ 08724

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/11/2016 02/10/2019
ROYSTER, TAHNESHA (CHHA)
30 RIDGE AVENUE
NEPTUNE, NJ 07753

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/24/2017
ROZO, GLADYS
374B HAMILTON STREET
SOMERSET, NJ 08873

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/2007
ROZVAGA, NADEZHDA
155 ALEXAUKEN CREEK ROAD
LAMBERTVILLE, NJ 08530

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2009
RUANE, JOSEPH T. (DC)
314 WILLOW DRIVE
LITTLE SILVER, NJ 07739

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/8/1997
RUBBANI, MARIAM (LPN)
280 SOUTH HARRISON STREET
EAST ORANGE, NJ 07017

NPI-1801939723
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2018
RUBINSTEIN, CHARLES (RPH)
45 LAUREL AVENUE
LINWOOD, NJ 08221

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

8/20/2006
RUCHELMAN, TRINA (DDS)
2120 ROUTE 70
MANCHESTER, NJ 08759

NPI-1356425474
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2019
RUDOLPH, HERBERT (MD)
317 EAST MAIN STREET
TUCKERTON, NJ 08087

NPI-1871633370
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/14/2016 2/19/2020
RUFFIN, SHARALYN (CHHA)
OAKDALE VILLAGE TRAILER #52
CRANBURY, NJ 08512

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
RUGGIERO, PAULA E. (RN)
29 PARKWAY DRIVE
WESTVILLE, NJ 08093

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
RUIZ, DANIEL AKA DANILE (OWNER)
596 ELM STREET
KEARNY, NJ 07032

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/25/2011 11/24/2014
RUIZ, DORIS
909 WEST 7TH STREET
PLAINFIELD, NJ 07063

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/14/2007
RUIZ, JENNIFER
38 S. BRIDGEBORO STREET
DELRAN, NJ 08075

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/21/2016
RUIZ, LORRAINE (CHHA)
1131 N. 19TH STREET
CAMDEN, NJ 08105

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/5/2019
RULDAN, THOMAS (LPN)
301 OHIO AVENUE
PHILLIPSBURG, NJ 08865

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2001
RUMMA, CHRISTINE DONNA
164 STARBOARD STREET
FORKED RIVER, NJ 08731

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/26/2000 Permanent
RUSH, DALE (LPN)
182 PRESTON ROAD, APT. H2
MILFORD, NJ 08848

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/11/2019
RUSH, DAVID A.
5755 PFEIFER CIRCLE
GERMANSVILLE, PA 18053

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/19/1999 Permanent
RUSH, DAVID A.
5755 PFEIFER CIRCLE
GERMANSVILLE, PA 18053

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

10/11/2000 Permanent
RUSHING, GARY (DC)
70 BROAD STREET, SUITE B
MATAWAN, NJ 07747

NPI-1538315478
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

1/20/2002
RUSSELL JR., BERTRAM R. (MD)
USP HAZELTON, BOX 2000
BRUCETON MILLS, WV 26525

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

12/28/2014
RUSSELL, FERNESE D. (CNA)
666 E. 26TH STREET
PATERSON, NJ 07504

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

3/24/2002
RUSSELL, ROBERT J. (DC)
1645 B-BLACKWOOD CLEMENTN
BLACKWOOD, NJ 08012

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/2/1995 Permanent
RUSSO, GRACE (RN)
17 MAPLE PLACE
KEYPORT, NJ 07735

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/30/2019
RUSSOMANNO, RAYMOND (MD)
BLOOMFIELD AVENUE
BLOOMFIELD, NJ 07003

NPI-1093702532
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

11/28/2007
RUTA, EUGENIO (DC)
189 6TH AVENUE
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/21/2008
RUTIGLIANO, MICHAEL (MD)
1 SEARS DRIVE
PARAMUS, NJ 07652

NPI-1740348077
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2016
RYAN, GERALDINE (RN)
228 RIDGE AVENUE
LAKEWOOD, NJ 08701

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
RYAN, JAMES
267 SEACLIFF AVE
SEACLIFF, NY 11579

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

4/1/1996 4/1/2004
RYAN, MICHELE K. (LPN)
656 WHITE HORSE PIKE
HAMMONTON, NJ 08037

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
RYAN, THOMAS
D17-25 HUNTS POINT CORP
BRONX, NY 10474

NPI-
Vendor
Criminal Offense
Suspension

Treasury
Treasury Purchase Bureau

9/7/2000 Permanent
RYBALOV, SEMEN
BERGEN COUNTY JAIL, PO BOX 0369
HACKENSACK, NJ 07601

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/28/2015
RYTEL, SYLVIA (LPN)
634 INDIANA AVENUE
TRENTON, NJ 08638

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/3/2019
SAADY, JACK R. (RPH)
281 ROUND HILL DRIVE
FREEHOLD, NJ 07728

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/11/2000 Permanent
SABA-KHALIL, ROSALY (MD)
531 SUMMIT AVENUE
FRANKLIN LAKES, NJ 07417

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/1995 Permanent
SABATE, NEONITA (RN)
PO BOX 4004
CLINTON, NJ 08809

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/27/2001 Permanent
SABBAGHZADEH, ANDREW A.
108 BRANDON ROAD
EAST SYRACUSE, NY 13057

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2012
SABIDO, BENJAMIN A. (MD)
805 11TH STREET
UNION CITY, NJ 07087

NPI-1720159916
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/26/2015
SACCA, COLLEEN (RN)
310 GARFIELD AVENUE
PALMYRA, NJ 08065

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
SACHER, PHILIP
558 ANDERSON AVE
CLIFFSIDE PARK, NJ 07010

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

5/6/1986 Permanent
SADARANGANI, BHAGWAN (MD)
240 LYNCREST ROAD
ENGLEWOOD CLIFF, NJ 07632

NPI-1386790665
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/28/2011
SADLER, RUFUS (MD)
2 LAWRENCE STREET
MOUNT VERNON, NY 10552

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
FINNEGANS PLAZA PHARMACY
11507 FINNEGANS LANE
NEW BRUNSWICK, NJ 08902

SAEED,MOHAMMED
1507 FINNEGANS LANE
NEW BRUNSWICK, NJ 08902

NPI-

Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/16/1998 Permanent
SAFIER, GARY (DO)
8 QUARRY COURT
RANDOLPH, NJ 07869

NPI-1558478529
Medical
Antitrust/Anti-Kickback Acts
Debarment

Human Services
Medical Assistance (Medicaid)

4/1/2016
SALAAM, ABDUL J. (MD)
1153 SOUTH ORANGE AVE
NEWARK, NJ 07103

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/7/1997 Permanent
SALAGA, JENNIFER (RN)
248 WARD AVENUE
BORDENTOWN, NJ 08505

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/28/2017
SALAMI, ADEMOLA T.
HARVARD AVENUE
HILLSIDE, NJ 07205

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/15/2008
BETHEL PHARMACY
112 POND LANE
LINWOOD , NJ 08221

SALARTASH, KHASHAYAR (MD)
112 POND LANE
LINWOOD, NJ 08221

NPI-1457376006

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

10/27/2009 10/7/2011
SALEMA, JOSEPH
101 EAST ELM STREET
WENONAH, NJ 08090

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/4/1998 Permanent
SALITA, CONRAD C. (MD)
1 N. VALLEY AVENUE
VINELAND, NJ 08360

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/29/1995 Permanent
SALKIND, SCOTT A. (DO)
611 KINGS CROFT
CHERRY HILL, NJ 08034

NPI-1750401949
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/14/2000
SALOMONE, JOSEPH (DC)
53 COLLURA LANE 39
CLIFTON, NJ 07012

NPI-1609019140
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/20/2015
SALUJA, DHANBIR (MD)
230 JEFFERSON STREET
NEWARK, NJ 07105

NPI-1023045010
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/24/2013
SALUJA, DHANBIR (MD)
230 JEFFERSON STREET, FL 1
NEWARK, NJ 07105

NPI-1023045010
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/3/2016
G.F.I. Siteworks, Inc.G.F.I. Siteworks, Inc.
362 Friendship Road
Clarksboro, NJ 08020

Salvatore A Casella III, President
PO Box 296
Clarksboro, NJ 08020

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

2/3/2016 02/02/2019
SALVATORE JR., THOMAS
201 HAMILTON AVE
TRENTON, NJ 08609

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
SAMAN, AIAD L.
47 CENTER PLACE
STATEN ISLAND, NY 10306

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/25/2009
SAMI, ASHRAF
64 CARUTH AVENUE, APT. 66
ELMWOOD PARK, NJ 07407

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/24/2017
SAMILLAN, HANS (CHHA)
3-3 SYDNEY WAY
LONG BRANCH, NJ 07740

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
SAMUEL, DELORIS AKA SOUFFRONT
P.O. BOX 4004
CLINTON, NJ 08809

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/2/2008
SANCHEZ, MAURICE
243 PROSPECT AVENUE
NORTH ARLINGTON, NJ 07031

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/1/2011 4/30/2012
SANCHEZ, MELISSA (CHHA)
45 FRANKLIN PLACE
TOTOWA, NJ 07515

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/10/2018
SANDERLIN, KATHLEEN (RN)
824 SANIKAN TRAIL
SOUTHAMPTON, NJ 08088

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
SANDERS, DENISE (PHARM TECH)
4 DREXEL COURT
SAYERVILLE, NJ 08021

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/12/1995 Permanent
SANDERS, MICHAEL (THERAPIST)
4 CHERRY ROAD
NEWTOWN, NJ 07860

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/19/2006
SANDERSON, LYNN (LPN/RN)
120 GATES MILL COURT
TRENTON, NJ 08690

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/20/2005
SANDIEGO, NARDO (MD)
4 HEATHER HILL LANE
SUFFERN, NY 10901

NPI-1578508115
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

10/8/2013
SANGALANG, ALEX (RN)
21 LISA DRIVE
HAZLET, NJ 07730

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
SANGHERA, ANIL
105 PHEASANT FIELD LANE
MOORESTOWN, NJ 08057

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/20/2009
SANICO, ELAINE D. (DPM)
122 BRIGHT ST., #1W
JERSEY CITY, NJ 07302

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/19/1997
SANTA MARIA, DONNA L. (RN)
618 CINDER ROAD
EDISON, NJ 08820

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
SANTAN, ALICIRIO JOSE
141 ROUTE 130 SOUTH
CINNAMINSON, NJ 08077

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/23/2014 4/22/2017
SANTANA, SONIA (CHHA)
569 E. 33RD STREET
PATERSON, NJ 07613

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

3/28/2001 Permanent
SANTANGELO, FRANK (MD)
705 HAMBURG TURNPIKE
WAYNE, NJ 07470

NPI-1881785293
Medical
Antitrust/Anti-Kickback Acts
Disqualification

Human Services
Medical Assistance (Medicaid)

11/22/2016
SANTANGELO, FRANK (MD)
FCI-FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1881785293
Medical
Antitrust/Anti-Kickback Acts
Disqualification

Human Services
Medical Assistance (Medicaid)

3/13/2017
SANTANIELLO, RICHARD J.
5 BUGLE COURT
HOWELL, NJ 07731

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

3/20/2002
SANTIAGO JR., EDDIE (MD)
300 SECOND AVENUE
LONG BRANCH, NJ 07740

NPI-1497796973
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/1/2014 8/22/2019
SANTIAGO, HEDBERTO (CNA)
3265 S. US HIGHWAY 1, LOT 6
FORT PIERCE, FL 34982

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2020
SANTIAGO, RANALDO
GIBBSBORO RD.
LINDENWOLD, NJ 08021

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2007 Permanent
SANTIAGO, REYNALDO (MD)
1502A MARCY PLACE
PHILADELPHIA, PA 19115

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/16/1997 Permanent
SANTIAGO, RUTH M. (CHHA)
289 BROADWAY, APT. E
NEWARK, NJ 07104

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/19/2001
SANTIAGO, VANESSA
35 AMHERST ROAD
SOUTH TOMS RIVE, NJ 08757

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

5/31/2006
SANTIAGO-JIMINEZ, HERIBERTO
396 WOODLAND AVENUE
SOUTH AMBOY, NJ 08879

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2011
SANTOS - ARIAS, SIMON (MD)
10305 NW 7TH COURT
PLANTATION, FL 33324

NPI-1497721062
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/18/2016
SANTOS, MICHAEL
988 JOHNSON PLACE
UNION, NJ 07083

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

11/27/2013 11/26/2016
SAPERSTEIN, ALAN
30 HIGHLAND RD-DIX HILLS
LONG ISLAND, NY 11746

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/1/1987 Permanent
SARKODIE, ALEX (MD)
516 YORKTOWN ROAD
UNION , NJ 07083

NPI-1598870271
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/14/2016
SARKODIE, ALEX (MD)
516 YORKTOWN ROAD
UNION, NJ 07083

NPI-1598870271
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/5/2017
SARVAIYA, RAMESH (MD)
26 EASTWOOD DRIVE
VOORHEES, NJ 08043

NPI-1578558748
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/14/2021
SATCHER, WILLIAM
558 ANDERSON AVENUE
CLIFFSIDE PARK, NJ 07010

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
SAUCHELLI, FRANCIS (MD)
151 BLOOMFIELD AVENUE, APT. 502
VERONA, NJ 07044

NPI-1124586326
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

9/13/2019
SAUL, STEPHEN L. (DPM)
9 SEASIDE COURT
MARGATE CITY, NJ 08402

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016 Permanent
SAUL, STEPHEN L. (DPM)
76 W. JIMMIE LEEDS ROAD
ABSECON, NJ 08201

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/18/2001 Permanent
SAVINO, THOMAS (MD)
65 BUTTONWOOD ROAD
STATEN ISLAND, NY 10304

NPI-1821087305
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/10/2018
SAVINO, THOMAS (MD)
FCI FORT DIX, PO BOX 2000
JOINT BASE MDL, NJ 08640

NPI-1821087305
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
SAYED, SAQUIB (MD)
4 TURTLE HOLLOW COURT
SICKLERVILLE, NJ 08051

NPI-1609054360
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

4/29/2016
SAYED-BAKHATY, ABDEL (MD)
403 HARMON TOWERS
SECAUCUS, NJ 07094

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/26/1995
SAYEGH, RICKY (MD)
4 FOWLER AVENUE
YONKERS, NY 10701

NPI-1346274966
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/19/2016
SAYEGH, RICKY (MD)
390 FORT HILL ROAD
SCARSDALE, NY 10583

NPI-1346274966
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

11/20/2017
SBARRA, SAMUEL
PARK AVENUE
NUTLEY, NJ 07110

NPI-1205913100
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2008 1/20/2015
SCARPITTA, JANET
92 PEABODY PLACE
NEWARK`, NJ 07104

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/15/2001 Permanent
SCERBO, ERNEST J. (MD)
26 01 BROADWAY SUITE 103
FAIR LAWN, NJ 07410

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 DECEASED
SCHECHTER, MARVIN (OD)
100 YORKTOWN DR
MT LAUREL, NJ 08054

NPI-1063420453
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/1/1993 Permanent
SCHEIN, HERBERT W. (MD)
1027 HOOPER AVENUE
TOMS RIVER, NJ 08753

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)

5/30/1991 DECEASED
SCHEINER, DAVE E. (DPM)
910 BONAPARTE COURT
PHILADELPHIA, PA 19107

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/22/1999
SCHENKEL, CATHERINE (RN)
87 IRVING AVENUE APT. 3
LIVINGSTON, NJ 07039

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2009
SCHENKEL, CATHERINE (RN)
87 IRVING AVENUE APT. 3
LIVINGSTON, NJ 07039

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/30/2010
SCHIVAO, JOHN
6 JUSTA LANE
CHERRY HILL, NJ 08003

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/13/2014 1/12/2017
SCHLACHTER, ANDREA
42 WEST HOLLY STREET
CRANFORD, NJ 07016

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006
SCHLEMBACH, ANDREA AKA OLIVER, ANDREA (APN/RN)
70 COHANSEY STREET
BRIDGETON, NJ 08302

NPI-1780630418
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016 5/21/2020
SCHLISSERMAN, HERMAN
300 48TH STREET
UNION CITY, NJ 07087

NPI-
Medical
Industry Law Violation
Disqualification

Human Services
Medical Assistance (Medicaid)


Permanent
SCHMIDT, NORINE (RN)
78 S. ROOSEVELT SQUARE
ENGLEWOOD, NJ 07631

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/12/2018
SCHMOLK, DERICK (RN)
11 BEVIS LANE
CAPE MAY COURT HOUSE, NJ 08210

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/25/2019
SCHMUCKER-KARPOW, CELESTE (MD)
50 MAPLE AVENUE
MORRISTOWN, NJ 07960

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

12/27/1995 DECEASED
SCHNEIDER, BRUCE J. (DDS)
520 CLIFFORD AVENUE, E8
MATAWAN, NJ 07747

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

7/20/2006
SCHOBERT III, WILLIAM B.
25 WELLINGTON DRIVE, #D
LUMBERTON, NJ 08048

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/20/2009 7/14/2014
SCHRAGER, KENNETH J. (MD)
FCI - OTISVILLE, PO BOX 600
OTISVILLE, NY 10963

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/19/2001
SCHROEDER, PETER (RN)
18 PILGRIM WAY
HAMILTON, NJ 08620

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

10/11/2017
SCHULTZ, STEVEN (MD)
1495 EAST 92ND STREET #2
BROOKLYN, NY 11236

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/9/1999 Permanent
SCHUMN, OTTO
678 BURKE STREET
WESTWOOD, NJ 07670

NPI-
Professional
Industry Law Violation
Disqualification

Law and Public Safety
Consumer Affairs Board of Architects

6/1/1993 Permanent
SCHUTT, CHARLES HARDEN
21 PARMLEY ROAD
TINTON FALLS, NJ 07724

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

3/8/1978 Permanent
INDUS. PRESCR. SVCS. INC.
60 SIP AVENUE
JERSEY CITY, NJ 07306

SCHWARTZ, EDWARD R. (RPH)
60 SIP AVENUE
JERSEY CITY, NJ 07306

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/6/1998 RETIRED
SCHWARTZ, EDWARD R. (RPH)
720 HARMON COVE TOWERS
SECAUCUS, NJ 07094

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

1/17/2001 RETIRED
SCHWARTZ, EDWARD R. (RPH)
1021 HERALD STREET
REDLANDS, CA 92374

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/20/2000 RETIRED
SCHWARTZ, GEORGE ROBERT
PO BOX 1806
SANTA FE, NM 87504

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/19/2007
SCHWARTZ, JADE (LPN)
97 SHORELAND CIRCLE
SOUTH AMBOY, NJ 08879

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/21/2018
SCHWARTZ, MARK L. (MD)
308 CHELSEA MANOR
PARK RIDGE, NJ 07656

NPI-1164436325
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

11/16/2018
SCHWARTZ, MURRAY (DO)
5 AUTUMN COURT
CHERRY HILL, NJ 08003

NPI-1063573012
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/23/2013
SCHWARTZ, MURRAY (DO)
5 AUTUMN COURT
CHERRY HILL, NJ 08003

NPI-1063573012
Medical
Criminal Offense
Debarment

Human Services
Medical Assistance (Medicaid)

12/5/2013
SCHWARZ, DENISE (DPM)
1729 PAMMEL PARK ROAD
WINTERSET, IA 50273

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

2/20/2002
SCIUBBA, ALFRED
3 CHADWICK DR.
VOORHEES, NJ 08043

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

10/22/2013 10/21/2016
SCOPELLITI, ALDO R. (DC)
107 MONMOUTH ROAD
W. LONG BRANCH, NJ 07764

NPI-1568524049
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/12/2000
Blue Skies Electric L.L.C.
326 Coles Mill Road
Williamstown, NJ 08094

Scott Frasca, Manager
326 Coles Mill Road
Williamstown, NJ 08094

NPI-

Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

1/7/2014 01/06/2017
SCOTT, DEBRA
2751 S. OCEAN DRIVE
HOLLYWOOD, FL 33019

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/20/2004
SCOTT, GLENN (RN)
70 POLIFLY RD. APT. 105
HACKENSACK, NJ 07601

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/18/2001
SCOTT, MARVELL (MD)
41 FIDDLERS WAY
SPARTA, NJ 07871

NPI-1144417478
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

8/12/2020
SCOTT, MCKENZIE (LPN)
457 REDBANK ROAD
TEMPLETON, PA 16259

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

11/20/2015
SCOTT, MELVIN
42 HIGHLAND TERRACE
IRVINGTON, NJ 07111

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

6/3/2001
SCULLION, FRANCES (RN)
20 BREAKNECK ROAD
OAKLAND, NJ 07436

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

7/13/1988 Permanent
SCURKO, RAYMOND E.
12 TOMAHAWK TRAIL
DENVILLE, NJ 07834

NPI-
Vendor
Industry Law Violation
Suspension

Treasury
Treasury Purchase Bureau

10/12/2004
SCURRY, MARSHAYA (PHARM TECH)
1500 GARDEN DRIVE
OCEAN, NJ 07712

NPI-
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

1/4/2017 6/26/2018
SEAMAN, VIVIAN (RN)
823 TENTH STREET
UNION BEACH, NJ 07735

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
SEDEHI, AHMAD (DMD)
31 JANE DRIVE
ENGLEWOOD CLIFFS, NJ 07632

NPI-1063634640
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

7/1/2017
SEGLIN, MARK (PSYCH)
89 LAPIS CIRCLE
WEST ORANGE, NJ 07052

NPI-1184754632
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

1/1/2017
Segundo E. Llivicota, Member

,

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

6/30/2015 6/29/2018
SEHGAL, GAUTAM (MD)
8 WINDERMERE COURT
LIVINGSTON, NJ 07039

NPI-1497801740
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

5/2/2016
SEHGAL, SHASHIBALA (MD)
630 FT. WASHINGTON AVENUE
NEW YORK, NY 10040

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

12/31/2000 10/17/2018
HANAN PHARMACY, INC.
47 NORWOOD AVENUE
CLIFTON, NJ 07011

SELIM, HANAN (RPH)
47 NORWOOD AVENUE
CLIFTON, NJ 07011

NPI-

Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

5/30/2000
SELLITTI, PAT
870 LAMONT AVENUE
STATEN ISLAND, NY 10309

NPI-
Construction
Wage & Hour Violation
Debarment

Labor
Workplace Standards

4/16/2020 4/15/2020
22225902200
PATIENT COACH MED TRANSP
724 GROVE ST
IRVINGTON, NJ 07111

SEMPLE, IVRY
724 GROVE ST
IRVINGTON, NJ 07111

NPI-

Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

12/24/1985 Permanent
SEMPLE, IVRY
472 LAKESIDE AVE.
ORANGE, NJ 07050

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/14/1986 Permanent
SENAPE, SAVERIO (MD)
215 WEST 92ND STREET 15A
NEW YORK, NY 10025

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

8/5/1998 Permanent
SENATORE, SALVATORE (DC)
342 LINCOLN DRIVE
KENILWORTH, NJ 07033

NPI-1073653366
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

8/19/2010
SENDER, PAUL (MD)
30A WEST MAPLE AVENUE
MONSEY, NY 10952

NPI-1124321286
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

11/20/2006 12/22/2014
SENQUIZ, LUZ (COUNSELOR)
471 HIGHLAND AVE., APT.A
COLLINGSWOOD, NJ 08108

NPI-
Medical
Criminal Offense
Suspension

Human Services
Medical Assistance (Medicaid)

4/29/2003
SENTILLES, JEAN (MD)
150 W 56TH ST NO 509
NEW YORK, NY 10019

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

2/27/1992 Permanent
SEPAHBODY, CYRUS (DDS)
507 SUMMERFIELD AVENUE, APT. 2
ASBURY PARK, NJ 07712

NPI-1487706305
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

5/18/2019
SERENO, PATRICIA (RN/LPN)
18 SECRETARIAT STREET
HOWELL, NJ 07731

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2001
SERPE, JOSEPH (RN)
459 MAIN STREET
STATEN ISLAND, NY 10307

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

6/5/2017
SERRANO, KRISTINA (CHHA)
59 ARCADIA PLACE, #B
VINELAND, NJ 08360

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

2/8/2017
SESAY, CHERYL (LPN)
12 AVA AVENUE
SOMERDALE, NJ 08083

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

10/20/2002
SESSOMS, VALERIE
29 STRATFORD PLACE,APT 6J
NEWARK, NJ 07108

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/20/2012
SEUFERT, ANNA MARIE (CHHA)
5139 LAKE WORTH ROAD
GREEN ACRES, FL 33463

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

6/19/2014
SEXTON, JILL (RN)
5460 ROUTE 100
PLYMOUTH, VT 05056

NPI-
Medical
Criminal Offense
Disqualification

Human Services
Medical Assistance (Medicaid)

9/12/2016
SHACK, DANIEL (RPH)
2 GRACEHILL COURT, APT.
TITUSVILLE, NJ 08560

NPI-
Medical
Other
Suspension

Human Services
Medical Assistance (Medicaid)

9/20/2006
SHAH, JAYEN C. (MD)
MEADOWLANDS PARKWAY
SECAUCUS, NJ 07096

NPI-
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

7/26/1996 Permanent
SHAHINE, AYMAN (MD)
334 86TH STREET
BROOKLYN, NY 10024

NPI-1235341850
Medical
Other
Disqualification

Human Services
Medical Assistance (Medicaid)

4/1/2019
SHAKARJIAN, CARNIG C. (DPM)
MEADOWLANDS PARKWAY
EMERSON, NJ 07630

NPI-1720007743
Medical
Other
Debarment

Human Services
Medical Assistance (Medicaid)

6/25/2013
SHARIF, MUDASSAR (MD)
308 MOUNTAIN ROAD
BASKING RIDGE, NJ 07920

NPI-1366509903
Medical
Other