NEW YORK STATE WORKERS' COMPENSATION BOARD …

1 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESPODIATRISTSPHONENEWNAME/ADDRESSLICE NSE # TreatIMEBATORFALVY BOHDAN ANDREWDPM006603P06603-6B9/22/20169/22/20 16 MOUNT KISCONY10549-BERKOWITZ-BERLINER JILL MANDIDPM005061P05061-8B3/1/19967/31/2002 MOUNT KISCONY10549-BERLINER RICHARD ALANDPM005062P05062-6B1/29/19966/19/2001 MOUNT KISCONY10549-CAPPA JOHNDPM004213P04213-6B7/28/19893/20/2001 VALHALLANY10595-CONNOLLY FIONA GERALDINEDPM005334P05334-9B7/17/20005/15 /2001 RYENY10580-DE MEO JAMES RDPM005041P05041-0B12/19/19943/20/2001 KATONAHNY10536-DEMOLEAS SPERO EVANDPM004380P04380-3B8/2/20128/2/2012 ARDSLEYNY10502-DORAZI STEPHEN THEODOREDPM004225P04225-0B10/10/19895/22 /2001 MAMARONECKNY10543-GUBERMAN RONALD MARKDPM004232P04232-6B3/14/19905/22/2001 MAMARONECKNY10543-HERSTIK IVAN GREGDPM004237P04237-5B4/10/20014/10/2001 YONKERSNY10710-PETERS ERICDPM003112P03112-1B2/20/19817/6/2001 WHITE PLAINSNY10601-RIVERA MORELL MARIOLADPM006721P06721-6B10/19/201510/19 /2015 WHITE PLAINSNY10601-ROCKMACHER LARRIE STEVENDPM002177P02177-5B11/9/19665/29/20 01 MOUNT KISCONY10549-RUBIN MITCHELLDPM004132P04132-8B9/8/19923/27/2 019 LARCHMONTNY10538-TOMBACK WILLIAMDPM002882P02882-0B11/10/19786/18/ 2001 SOMERSNY10589-VISCOVICH JOHN BRUNODPM005723P05723-3B2/24/20042/24/200 4 SOMERSNY10589-WEINFELD GLENN DAVIDDPM005939P05939-5B4/20/20162/24/200 4 YORKTOWNHEIGHTSNY10598-* - Indicates that the provider is new this month6/12/2019 Page 1 of 17 AUTHORIZATION # SUFFIX

2 KEY: W - WCB Treat Only, I - IME Only, B - Both IME and WCB TreatIME Authorized Providers Effective March 20, 2001 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESPSYCHOLOGISTSPHONENEWNAME/ADDRESSLI CENSE # TreatIMEBAER BARBARA SPSY009494S09494-6B6/8/19985/7/2019 ARDSLEYNY10502-BUTTERS JONATHAN WPSY008842S08842-7B5/28/19948/22/2001 HASTINGS-ON-HUDSONNY10706-COHEN MARTIN SPSY004649S04649-0B10/7/19933/20/2001 LARCHMONTNY10538-DUBRO ALAN FRAZIERPSY009323S09323-7I1/4/2019 NEWROCHELLENY10804-FENICHEL ANNPSY014160S14160-6B1/8/200712/4/2018 HASTINGS ONHUDSONNY10706-GOLDMAN DEBRA HEIDECORNPSY013223S13223-3B6/8/19986/25/ 2001 SCARSDALENY10583-INTRILIGATOR ROXANNPSY019892S19892-9B4/3/20134/3/2013 CROTON ONHUDSONNY10520-KALMANSON JULIAPSY021142S21142-5B9/27/20189/27/201 8 MOUNT KISCONY10549-LONDIN

3 VICTORIA LPSY009379S09379-9B6/1/19946/11/2010 CROSS RIVERNY10518-MATHEWS ANGELA LOUISEPSY011674S11674-9B1/13/20065/12/20 03 IRVINGTONNY10533-RADCLIFFE NICHOLASPSY015286S15286-8B2/21/20062/21/ 2006 MAMARONECKNY10543-REMBERT CECILIAPSY018644S18644-5B2/16/20162/16/2 016 YORKTOWNHEIGHTSNY10598-RUBIN JOANNE LESLIEPSY013019S13019-5B12/30/201112/30/ 2011 HARTSDALENY10706-RUMALDO ANGIE APSY018514S18514-0B5/18/20115/18/2011 YONKERSNY10705-SEIDMAN SUSAN MYRNAPSY009927S09927-5B3/2/19989/10/2001 SCARSDALENY10583-STEIN NORMAN DONALDPSY008306S08306-3B3/2/199811/6/200 1 WHITE PLAINSNY10606-TEPP ALAN VIGNALEPSY008068S08068-9B9/15/19975/30/2 002 MOUNT KISCONY10549-THORNTON DENNIS RPSY008682S08682-7B5/7/199211/6/2001 PLEASANTVILLENY10570-WEINBERGER MARK IANPSY018126S18126-3I12/24/2018 TARRYTOWNNY10591-* - Indicates that the provider is new this month6/12/2019 Page 2 of 17 AUTHORIZATION # SUFFIX KEY.

4 W - WCB Treat Only, I - IME Only, B - Both IME and WCB TreatIME Authorized Providers Effective March 20, 2001 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESCHIROPRACTORSPHONENEWNAME/ADDRESSLI CENSE # TreatIMEBIFFER LYDIA EDC002459C02459-8B4/15/19824/3/2001 JEFFERSONVALLEYNY10535-BISOGNI LOUIS EDC001943C01943-2B3/3/19783/20/2001 WHITE PLAINSNY10605-CAPOLINO THOMAS FRANCISDC011081C11081-9B10/27/200510/27/ 2005 TARRYTOWNNY10591-CARUSO MARCO AGOSTINODC010167C10167-7B11/8/200111/30/ 2005 SCARSDALENY10583-DAVIS JUDD PAULDC009805C09805-5B4/29/20024/29/2002 OSSININGNY10562-DIAB SALIMDC008720C08720-7B2/23/19993/20/2001 NEWROCHELLENY10801-DIAMOND LEEDC002408C02408-5B7/23/19803/20/2001 WHITE PLAINSNY10601-DRUCKER ERIC CDC004559C04559-3B12/23/19863/20/2001 MOUNT KISCONY10549-EGLAUF DOUGLAS

5 ROYDC001515C01515-8B6/11/19743/20/2001 WHITE PLAINSNY10605-FINEWOOD RICHARD LOUISDC008197C08197-8B6/15/19993/20/2001 OSSININGNY10562-FIORITO GEOFFREY ARNOLDDC009512C09512-7B1/11/20003/20/200 1 PELHAMNY10803-FRANTZESKOS CHRISTINAMAZZELLADC007011C07011-2B11/27/ 19923/20/2001 CHAPPAQUANY10514-FRIEDMAN JEFFREY ALANDC007065C07065-8B9/21/19923/20/2001 SLEEPY HOLLOWNY10591-HARVEY RICHARD GOLDDC004458C04458-8B5/19/19864/14/2006 YONKERSNY10701-HELMAN MAXINE HEATHERDC008808C08808-0B3/23/19984/3/200 1 SCARSDALENY10583-HONG DAVIDDC011696C11696-4B9/21/20109/21/2010 ARDSLEYNY10502-KAPLAN MARCDC002656C02656-9B8/5/19814/3/2001 HASTINGS-ON-HUDSONNY10706-KELLER ERIC NELSONDC005648C05648-3B3/20/19893/20/200 1 YONKERSNY10704-KOSTERICH STEVEN EDC006076C06076-6B11/1/19904/3/2001 NEWROCHELLENY10805-KRIEGER GLENN MICHAELDC009737C09737-0B3/20/20013/20/20 01 MAMARONECKNY10543-* - Indicates that the provider is new this month6/12/2019 Page 3 of 17 AUTHORIZATION # SUFFIX KEY.

6 W - WCB Treat Only, I - IME Only, B - Both IME and WCB TreatIME Authorized Providers Effective March 20, 2001 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESCHIROPRACTORSPHONENEWNAME/ADDRESSLI CENSE # TreatIMELAMBERT RONALD JEFFREYDC004032C04032-1B2/14/19853/20/20 01 RYEBROOKNY10573-LANDESBERG STUART NEALDC005183C05183-1B12/17/19875/10/2019 MONTROSENY10548-LANDI DENISE DELIADC004566C04566-8B11/17/19874/3/2001 YONKERSNY10701-LAVELLE DENNIS PATRICKDC009321C09321-3B7/28/19993/20/20 01 BRIARCLIFFMANORNY10510-MAZAHREH SAMER BASSAMDC009616C09616-6B3/23/20004/3/2001 NEWROCHELLENY10801-MILLER FLOYD EDC003824C03824-2B11/8/19843/20/2001 CORTLANDTMANORNY10567-MONK ROBERTDC005090C05090-8B9/8/19873/20/2001 OSSININGNY10562-MORICONE LAWRENCEDC004290C04290-5B11/21/19853/20/ 2001 WHITE

7 PLAINSNY10605-MUSCOLINO PAUL ADC000251C00251-1B7/1/19744/29/2002 SCARSDALENY10583-NYKWEST GLENDC002303C02303-8B9/18/19793/20/2001 PLEASANTVILLENY10570-PAULE MICHAEL ADC006879C06879-3B5/12/19927/25/2016 TARRYTOWNNY10591-PLAWSKI MARIE JENNIFERDC008627C08627-4B10/27/19973/20/ 2001 HARTSDALENY10530-PRYLUCKI HELENE CDC001896C01896-2B11/22/19745/6/2009 PORT CHESTERNY10573-RABADI MAYSDC009562C09562-2B3/23/20004/3/2001 YONKERSNY10705-RUSSO CHRISTIAN JDC012030C12030-5B7/22/20117/22/2011 SHRUB OAKNY10588-SACCHETTI TINADC004751C04751-6B9/18/19879/22/2016 ARMONKNY10504-SAYEGH PETER KDC010710C10710-4B9/18/20039/18/2003 YONKERSNY10701-SILVERMAN ROBERT GORDONDC009627C09627-3B5/22/20017/11/200 1 WHITEPLAINSNY10605-THOMAS NOBLE ADC012866C12866-2B12/30/201612/30/2016 HAWTHORNENY10532-TROTTA KENNETH MICHAELDC005136C05136-9B9/8/198711/22/20 05 SCARSDALENY10583-* - Indicates that the provider is new this month6/12/2019 Page 4 of 17 AUTHORIZATION # SUFFIX KEY.

8 W - WCB Treat Only, I - IME Only, B - Both IME and WCB TreatIME Authorized Providers Effective March 20, 2001 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESCHIROPRACTORSPHONENEWNAME/ADDRESSLI CENSE # TreatIMEWARDEN CHRISTOPHER THOMASDC007247C07247-2B8/31/19933/20/200 1 YORKTOWNHEIGHTSNY10598-WATTENMAKER ALLAN ROSSDC009236C09236-3B6/28/20026/28/2002 BEDFORDNY10506-WEINER MITCHELL ADC002032C02032-3B4/25/19784/2/2001 YONKERSNY10701-WEISS ROGER ALLENDC004258C04258-2B7/24/198512/28/201 8 YONKERSNY10710-WOLIN SETH MDC005432C05432-2B6/24/19883/20/2001 ARMONKNY10504-YOUNG GARYDC003307C03307-8B11/27/19933/20/2001 HARTSDALENY10530-ZIMBARDO JONATHAN SCOTTDC006140C06140-0B9/10/19903/20/2001 EASTCHESTERNY10709-* - Indicates that the provider is new this month6/12/2019 Page 5 of 17 AUTHORIZATION

9 # SUFFIX KEY: W - WCB Treat Only, I - IME Only, B - Both IME and WCB TreatIME Authorized Providers Effective March 20, 2001 COUNTYNEWYORK STATE WORKERS' COMPENSATION BOARDAUTHORIZED PROVIDERS - NAME ORDER REPORTWESTCHESTERSPECIALTYAUTHORIZATION # / DATESPHYSICIANS(INCLUDES OSTEOPATHS)PHONENEWNAME/ADDRESSLICENSE # TreatIMEABRAMOV RAFAELOPCPMR261232261232-3B10/19/20114/1 6/2012 NEWROCHELLENY10801-CIM-PDAGARWAL ARUNCIM170265170265-3B3/18/19915/29/2001 CHAPPAQUANY10514-AGRAWAL VIKAS KUMARCPN-N273140273140-4B11/25/201511/25 /2015 ARDSLEYNY10502-ALAMPAKEEZA ANDALEEBCOG291854291854-8B11/20/201811/2 0/2018 MOUNT KISCONY10546-CPA-CYALASIO TERESA MARIECPA-AP221179221179-5B5/23/20175/23/ 2017 MOUNT KISCONY10549-ANDRUS STEPHEN GCPMR208262208262-6B11/15/200111/15/2001 WEST HARRISONNY10604-ARNONE MARIA POPCAN196913196913-8B4/22/20169/11/2009 MOUNT KISCONY10549-AVITZUR ORLYCPN-N166530166530-6B1/7/19946/1/2001 TARRYTOWNNY10591-BALAKHANE EDMOND NEJATCR-DRA203666203666-3B7/9/20047/9/20 04 BEDFORD HILLSNY10507-BARDINELLI ANTHONY

10 JOSEPHCPN-P088156088156-5B3/27/19683/20/ 2001 WHITE PLAINSNY10603-BEHARRIE ANDREW WCOS231631231631-3B12/31/200712/31/2007 TARRYTOWNNY10591-BELLIN EVAN HILLELCPN-P112497112497-3B2/1/19954/2/20 01 NEWROCHELLENY10801-BERGER SAMUEL ALFREDCO234227234227-7B4/27/20104/27/201 0 BRIARCLIFFMANORNY10510-CR-NRADBERGER SCOTT BRUCECR-DRA193319193319-1B12/17/20094/19 /2011 MOUNT KISCONY10549-BERGSTEIN MICHAEL JCOL167019167019-9B2/1/20132/28/2019 YORKTOWNHEIGHTSNY10598-CIM-IDBERMAN DANIEL SOLOMONCIM155841155841-0B5/16/19884/17/2 001 NEWROCHELLENY10804-BERMAN EVAN NEALCS154345154345-3B6/17/19964/26/2001 YONKERSNY10701-BLAUFEUX BRIAN ALANCEM211488211488-2B2/11/20161/28/2014 YORKTOWNHEIGHTSNY10598-BOOTHE ROBERT LEE SANFORDCOS094646094646-7B7/19/19734/2/20 01 TARRYTOWNNY10591-BRAUNING MARK GUNTHERCIM244532244532-8B2/8/20165/17/20 10 MOUNT KISCONY10549-* - Indicates that the provider is new this month6/12/2019 Page 6 of 17 AUTHORIZATION # SUFFIX KEY.