HEPATITIS C MEDICAID PRACTITIONER LIST PRACTITIONER NPI PRACTITIONER LAST NAME PRACTITIONER FIRST NAME SPECIALTY CITY Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form. Last Updated (3/31/2018) 1 1144298613 ABDELSAYED GEORGE GASTROENTEROLOGIST STATEN ISLAND 1376565358 ABEMAYOR ELIE GASTROENTEROLOGIST MOUNT KISCO 1649472382 ABERGEL JEFFREY GASTROENTEROLOGIST STATEN ISLAND 1750375416 ABOUJAOUDE JOSEPH GASTROENTEROLOGIST STATEN ISLAND 1104059427 ABRAHAM BIJU GASTROENTEROLOGIST GARDEN CITY 1073570081 ADEONIGBAGBE OLUSEGUN GASTROENTEROLOGIST HOLLIS 1760477830 ADER MICHAEL GASTROENTEROLOGIST BRONX 1942448345 AGARWAL RITU GASTROENTEROLOGIST NEW YORK 1104898311 AHMAD JAWAD GASTROENTEROLOGIST NEW YORK 1821013442 ANAND SURYANARAYAN GASTROENTEROLOGIST BROOKLYN 1891732483 ARIF ASMA GASTROENTEROLOGIST TROY 1427062694 ARON JOSHUA GASTROENTEROLOGIST ELMHURST 1558398271 ARYA YASHPAL GASTROENTEROLOGIST BROOKLYN 1972619823 ASHKIN JEFFREY GASTROENTEROLOGIST BAY SHORE 1063439099 ATALLAH RAMI GASTROENTEROLOGIST BROOKLYN 1972578490 ATLURI PURNA CHANDRA PRASAD GASTROENTEROLOGIST BROOKLYN 1083618607 AUERBACH MITCHELL GASTROENTEROLOGIST YONKERS 1831138361 AUGELLO SABINO GASTROENTEROLOGIST ASTORIA 1417141664 BADALOV NISON GASTROENTEROLOGIST BROOKLYN 1679543888 BADALOV ILYA GASTROENTEROLOGIST RENSSELAER 1124000310 BANK LESLIE GASTROENTEROLOGIST BINGHAMTON 1962432476 BANSAL MEENA GASTROENTEROLOGIST NEW YORK
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HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
1
1144298613 ABDELSAYED GEORGE GASTROENTEROLOGIST STATEN ISLAND
1376565358 ABEMAYOR ELIE GASTROENTEROLOGIST MOUNT KISCO
1649472382 ABERGEL JEFFREY GASTROENTEROLOGIST STATEN ISLAND
1750375416 ABOUJAOUDE JOSEPH GASTROENTEROLOGIST STATEN ISLAND
1104059427 ABRAHAM BIJU GASTROENTEROLOGIST GARDEN CITY
1124000310 BANK LESLIE GASTROENTEROLOGIST BINGHAMTON
1962432476 BANSAL MEENA GASTROENTEROLOGIST NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
2
1053396572 BASU PRITHWIJIT GASTROENTEROLOGIST NEW YORK
1225029242 BATASH STEVEN GASTROENTEROLOGIST REGO PARK
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
3
1225053523 CHAN SING GASTROENTEROLOGIST FLUSHING
1043287857 CHAN WALLEN GASTROENTEROLOGIST STATEN ISLAND
1649299686 CHANG CHARISSA GASTROENTEROLOGIST NEW YORK
1205831658 CHASE MICHAEL GASTROENTEROLOGIST GLENS FALLS
1770696197 CHATALLASH ROBERT GASTROENTEROLOGIST BAY SHORE
1851353908 CHAUDHRY PC ABDUL GASTROENTEROLOGIST WARSAW
1134101785 CHERPAK RICHARD GASTROENTEROLOGIST UTICA
1225056070 DIETERICH DOUGLAS GASTROENTEROLOGIST NEW YORK
1548231160 DISTLER PETER GASTROENTEROLOGIST NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
1366460198 GREWAL PRIYA GASTROENTEROLOGIST NEW YORK
1851506869 GROSMAN IGOR GASTROENTEROLOGIST BROOKLYN
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
5
1821059668 GROSMAN IRWIN GASTROENTEROLOGIST NEW YORK
1013942085 GUTMAN JASON GASTROENTEROLOGIST ROCHESTER
1235279738 GUTWEIN JEREMY GASTROENTEROLOGIST BRONX
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
6
1861452245 KHDAIR ADNAN GASTROENTEROLOGIST NEW YORK
1053391482 LANGAN LAWRENCE GASTROENTEROLOGIST STATEN ISLAND
1770571135 LANTIN JOSE GASTROENTEROLOGIST YONKERS
1235390832 LAW LINDA GASTROENTEROLOGIST BROOKLYN
1619089513 LEBOVICS EDWARD GASTROENTEROLOGIST HAWTHORNE
1831249465 LEE YOUNG GASTROENTEROLOGIST LIVERPOOL
1568652261 LEE THOMAS GASTROENTEROLOGIST SYRACUSE
1265674998 LEONG JENNIFER GASTROENTEROLOGIST NEW YORK
1942285861 LESMAN ALAN GASTROENTEROLOGIST MELVILLE
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
7
1770547630 LI MICHAEL GASTROENTEROLOGIST FLUSHING
1437171683 LI JIANJUN GASTROENTEROLOGIST BROOKLYN
1487736054 LIDOFSKY STEVEN GASTROENTEROLOGIST BURLINGTON
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
8
1700880168 MULROONEY STEPHEN GASTROENTEROLOGIST STATEN ISLAND
1053534578 MUSLIM ARIF GASTROENTEROLOGIST NEW WINDSOR
1285693820 MUSTACCHIA PAUL GASTROENTEROLOGIST NEW YORK
1265598759 MYUNG JOON GASTROENTEROLOGIST FLUSHING
1972522936 NADAF ALBERT GASTROENTEROLOGIST BROOKLYN
1053598227 NAIK JAHNAVI GASTROENTEROLOGIST NEW YORK
1174732663 NARASIMHAN GOPAL GASTROENTEROLOGIST NEW YORK
1316912207 PELLEGRINI RICHARD GASTROENTEROLOGIST HEMPSTEAD
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
1689604191 SCHIANO THOMAS GASTROENTEROLOGIST NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
10
1215945738 SCHWARTZ JONATHAN GASTROENTEROLOGIST BRONX
1427030691 SCOYNI ROBERT GASTROENTEROLOGIST MIDDLETOWN
1063481778 SHAHIDULLAH ABUL GASTROENTEROLOGIST RIDGEWOOD
1952325599 SHAPSIS ALEXANDER GASTROENTEROLOGIST BROOKLYN
1063502235 TALAL ANDREW GASTROENTEROLOGIST BUFFALO
1750398566 TENNER SCOTT GASTROENTEROLOGIST BROOKLYN
1144212853 THANTAFILLORE NICHOLAS GASTROENTEROLOGIST JAMAICA
1720001043 TIFFT JAMES GASTROENTEROLOGIST SYRACUSE
1629261722 TIN HUI HING GASTROENTEROLOGIST BROOKLYN
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
1821189804 ZLATANIC JUSUF GASTROENTEROLOGIST NEW YORK
1396782629 BROWN ROBERT HEPATOLOGY NEW YORK
1376583930 DOVE LORNA HEPATOLOGY NEW YORK
1518136860 KALIA HARMIT HEPATOLOGY BRONX
1508936659 LEE TAI-PING HEPATOLOGY MANHASSET
1356308738 MALET PETER HEPATOLOGY MINEOLA
1639156318 STEHLIN MURIEL HEPATOLOGY EAST SETAUKET
1306291802 WOODS CHRISTOPHER HEPATOLOGY NEW YORK
1285621698 ADEDEJI ADEDAYO INFECTIOUS DISEASE STATEN ISLAND
1376625905 AFACAN YUSUF INFECTIOUS DISEASE BROOKLYN
1316259419 AKIYAMA MATTHEW INFECTIOUS DISEASE BRONX
1780698936 ALONSO GEORGE INFECTIOUS DISEASE ELMHURST
1104916907 ALPERT PETER INFECTIOUS DISEASE BRONX
1386745883 ANTONIOS VERA INFECTIOUS DISEASE BRONX
1437317658 ASIAGO-REDDY ELIZABETH INFECTIOUS DISEASE SYRACUSE
1295704963 BADEM OLGA INFECTIOUS DISEASE NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
13
1205817624 BAILEY JUAN INFECTIOUS DISEASE NEW YORK
1912173212 ECKHARDT BENJAMIN INFECTIOUS DISEASE NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
14
1134228208 EDLIN BRIAN INFECTIOUS DISEASE NEW YORK
1659311439 EL DAHER NAYEF INFECTIOUS DISEASE ROCHESTER
1578533394 HIRSCH BRUCE INFECTIOUS DISEASE MANHASSET
1205806023 HIRSCHWERK DAVID INFECTIOUS DISEASE MANHASSET
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
15
1134148489 HOOVER KAREN INFECTIOUS DISEASE NEW YORK
1336344241 JEBRAEILI JOHARI FATIMA INFECTIOUS DISEASE NEW YORK
1730260811 JENNY-AVITAL ELIZABETH INFECTIOUS DISEASE BRONX
1356474662 JOHNSON LIVETTE INFECTIOUS DISEASE NEW YORK
1225293301 JOSEPH GILIANE INFECTIOUS DISEASE BRONX
1861698490 KANG SEUNG HEE INFECTIOUS DISEASE NEW YORK
1740573468 KAPLAN-LEWIS EMMA INFECTIOUS DISEASE NEW YORK
1033199294 KIM ANGELA INFECTIOUS DISEASE MANHASSET
1447340245 KLEIN ROBERT INFECTIOUS DISEASE BRIARCLIFF MANOR
1043295926 KOSHY SANJANA INFECTIOUS DISEASE NEW YORK
1831427137 KOSHY ROBIN INFECTIOUS DISEASE MANHASSET
1063464519 KUTLER CHARLES INFECTIOUS DISEASE KINGSTON
1700888013 LANDMAN DAVID INFECTIOUS DISEASE BROOKLYN
1043372022 LEE GREGORY INFECTIOUS DISEASE NEW YORK
1073672762 LENOX THEODORE INFECTIOUS DISEASE NEW YORK
1134107774 LIPSKY WILLIAM INFECTIOUS DISEASE LONG BEACH
1689654840 MCGOWAN JOSEPH INFECTIOUS DISEASE MANHASSET
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
Last Updated (3/31/2018)
16
1821028051 MCMEEKING ALEXANDER INFECTIOUS DISEASE NEW YORK
1750375374 MILLER CYNTHIA INFECTIOUS DISEASE ALBANY
1942381405 MORA-MCLAUGHLIN FERNANDO INFECTIOUS DISEASE BRONX
1770760084 NORTON BRIANA INFECTIOUS DISEASE BRONX
1174847107 NG MICHEL INFECTIOUS DISEASE NEW YORK
1477729077 PATEL MARISH INFECTIOUS DISEASE BRONX
1558387431 PAUL JOSEPH INFECTIOUS DISEASE BROOKLYN
1235110651 PERLMAN DAVID INFECTIOUS DISEASE NEW YORK
1386671717 PERRY RUSSELL INFECTIOUS DISEASE NEW YORK
1700985199 PHAM VINH INFECTIOUS DISEASE NEW YORK
1346238912 POLLACK HENRY INFECTIOUS DISEASE NEW YORK
1912917816 PSEVDOS GEORGE INFECTIOUS DISEASE NEW YORK
1997999122 PUNJ SONIA INFECTIOUS DISEASE JAMAICA
1023003332 QUALE JOHN INFECTIOUS DISEASE BROOKLYN
1932214467 QUINTANILLA JULIO INFECTIOUS DISEASE BRONX
1760628820 REVERE ELIZABETH INFECTIOUS DISEASE MANHASSET
1295706497 RUSH THOMAS INFECTIOUS DISEASE BRIARCLIFF MANOR
1174505275 SALOMON NADIM INFECTIOUS DISEASE NEW YORK
1861653198 SARPEL DOST INFECTIOUS DISEASE NEW YORK
HEPATITIS C MEDICAID PRACTITIONER LIST
PRACTITIONER
NPI
PRACTITIONER
LAST NAME
PRACTITIONER
FIRST NAME SPECIALTY CITY
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
1477511673 WALDRON MARY INFECTIOUS DISEASE NEW YORK
1497817480 ARNON RONEN TRANSPLANT SURGERY NEW YORK
1821084211 MORGAN GLYN TRANSPLANT SURGERY NEW YORK
HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST
PRACTITIONER NPI
PRACTITIONER LAST NAME
PRACTITIONER FIRST NAME SPECIALTY CITY Date²
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months
and at least 10 HCV- related CME credits in the last 12 months.
² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.
(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)
1528011103 FEFER JOSE DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST
PRACTITIONER NPI
PRACTITIONER LAST NAME
PRACTITIONER FIRST NAME SPECIALTY CITY Date²
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months
and at least 10 HCV- related CME credits in the last 12 months.
² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.
(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)
19
1811095375 FERRIS DAVID DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
1790968360 LONDON KARYN DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018
HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST
PRACTITIONER NPI
PRACTITIONER LAST NAME
PRACTITIONER FIRST NAME SPECIALTY CITY Date²
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months
and at least 10 HCV- related CME credits in the last 12 months.
² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.
(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)
20
1669536496 MANCENIDO MICHAEL DEMONSTRATED EXPERIENCE¹ ROCHESTER 6/30/2018
1598712754 MARTINEZ ANTHONY DEMONSTRATED EXPERIENCE¹ BUFFALO 6/30/2018
1265838627 MELCHIORRE MICHELLE DEMONSTRATED EXPERIENCE¹ NEW YORK 9/30/2018
1952520603 MILANO DANIELLE DEMONSTRATED EXPERIENCE¹ NEW YORK 12/30/2018
1750439485 MORRISON ELLEN DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
1013354919 NEBO CHINYERE DEMONSTRATED EXPERIENCE¹ BRONX 12/30/2018
1932528197 NOCERINO ANGELICA DEMONSTRATED EXPERIENCE¹ NEW YORK 3/31/2019
1013025253 OLENDER SUSAN DEMONSTRATED EXPERIENCE NEW YORK 6/30/2018
1902976293 OSORIO GEORGINA DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
1407055734 PORTUESE THOMAS DEMONSTRATED EXPERIENCE1 GLENS FALLS 3/31/2019
1851370662 PRITCHETT KEVIN DEMONSTRATED EXPERIENCE¹ BRONX 9/30/2018
1467896480 QUARESIMA MARK DEMONSTRATED EXPERIENCE1 SOUTH GLENS FALLS 3/31/2019
1588745905 RAMSEY KELLY DEMONSTRATED EXPERIENCE¹ POUGHKEEPSIE, AMENIA 6/30/2018
1566592962 ROSA DANIEL DEMONSTRATED EXPERIENCE¹ BRONX 6/30/2018
1568750651 ROSMAN SCOTT DEMONSTRATED EXPERIENCE¹ BINGHAMTON 12/30/2018
1215197074 SCHERER MATTHEW DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
1003994930 SHALEV NOGA DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST
PRACTITIONER NPI
PRACTITIONER LAST NAME
PRACTITIONER FIRST NAME SPECIALTY CITY Date²
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months
and at least 10 HCV- related CME credits in the last 12 months.
² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.
(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)
21
1902831431 SIGEL KEITH DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
1215157235 SLINGERLAND DAVID DEMONSTRATED EXPERIENCE¹ SOUTH GLENS FALLS 9/30/2018
1184652067 WILDFEUER OLGA DEMONSTRATED EXPERIENCE¹ NEW YORK 3/31/2019
1154486082 ZELLAN JONATHAN DEMONSTRATED EXPERIENCE¹ BROOKLYN 6/30/2018
1801054093 ZEWDE MULUBRHAN DEMONSTRATED EXPERIENCE¹ NEW YORK 6/30/2018
HEPATITIS C MEDICAID EXPERIENCED PRACTITIONER LIST
PRACTITIONER NPI
PRACTITIONER LAST NAME
PRACTITIONER FIRST NAME SPECIALTY CITY Date²
Disclaimer: The Medicaid approved HCV practitioners list is not all inclusive. The Department makes every effort to provide current, accurate data, however practitioner information may not be represented or can change. If a practitioner is missing from our list they can submit a request to be placed on the list by completing the Medicaid Hepatitis C Practitioner information request form.
¹ - Demonstrated experience is defined as the management AND treatment of at least 10 patients with HCV infection within the past 12 months
and at least 10 HCV- related CME credits in the last 12 months.
² - Date is that of which the prescriber will need to renew their attestation for demonstrating experience and will require a renewal annually.
(Date)*- Providers that are currently under review for renewal and are considered “Demonstrated Experience” if listed. Last Updated 3/30/2018)