State of New Jersey Medicaid Fraud Division Provider ...

1 State of New Jersey Medicaid Fraud DivisionProvider Exclusion Report**ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**1 Updated on: 5/2/2022 For verifications please contact: an email to to receive this report in .xls formatPROVIDER NAMETITLEDATE OF BIRTHNPI NUMBERSTREETCITYSTATEZIPACTIONEFFECTIVE DATEEXPIRATION DATE2258 PHARMACY, THIRD AVENUENEW YORKNY10035 SUSPENSION7/20/20036522 VENTNOR AVE. PHARMACY, VENTNOR AVENUEVENTNORNJ08406 DISQUALIFICATIONABARCA, CHERYL 3RD STREETNEWARKNJ07107 SUSPENSION6/20/ 2005 ABASHKIN, ROMANCHHA12/21/198172 RIDGEVIEW TERRACEWAYNENJ07470 DISQUALIFICATION5/29/2015 ABASHKIN, ROMANCHHA12/21/198172 RIDGEVIEW TERRACEWAYNENJ07470 DISQUALIFICATION6/3/2016 ABBASSI, JADANMD9/19/194411948072551618 MAIN AVENUECLIFTONNJ07011 DISQUALIFICATION11/21/2016 PERMANENTABBASSI, JADANMD9/19/19441194807255115 NELLIS DRIVEWAYNENJ07470 DISQUALIFICATION6/20/2018 PERMANENTABDALLA, IZZELDIN4/5/19671116 ANNE STREETELIZABETHNJ07201 DISQUALIFICATION11/10/1999 ABDELGANI.

2 AMIRALLENWOOD USPWHITE DEERPA17887 DISQUALIFICATION11/26/2001 ABDELGANI, FADILTERRE HAUTE USPTERRE HAUTEIN47808 DISQUALIFICATION11/26/2001 ABDELHAMID, MANALRPH5/28/19697100 BOULEVARD EAST, 11 GGUTTENBERGNJ07093 DEBARMENT3/15/2001 ABDOLLAHI, MITRA DMD8/31/19661033329230646 N. SARATOGA DRIVEMOORESTOWNNJ08057 DISQUALIFICATION11/5/20077/19/2019 ABERBACH, STEVENRPH8/5/194423 STONEGATE DRIVEWATCHUNGNJ07069 DEBARMENT12/19/2003 ABOOD, ABDOLMAID BEVAN STREETJERSEY CITYNJ07306 SUSPENSION5/7/1997 ABOODS MEDICAL LIVERY64 BEVAN STREETJERSEY CITYNJ07306 DISQUALIFICATION5/22/1994 ABOUELHODA, AHMED RPH3/23/197433-17 60TH STREET, APT.

3 1 WOODSIDENY11377 SUSPENSION9/20/ 2005 ABRAHAMSEN, SVENDDPM9/17/1944101 CHESTNUT RIDGE ROADSADDLE RIVERNJ07458 DISQUALIFICATION4/20/1994 ABRAMS, DE'NYSHIACHHA11/16/1993410 3RD AVENUE, APT. 1 AASBURY PARKNJ07712 DISQUALIFICATION7/16/2018 ABRAMS, IRVINGRPH12/23/19495 LORENE WAYMORGANVILLENJ07551 SUSPENSION4/27/2000 ABREU MARTINEZ, CHHA12/14/198914 EAST RUSSELL STREETCLIFTONNJ07011 DEBARMENT10/31/2017 ABUSEF, ELSAYED MED. TRANSPORT814 74TH STREETNORTH BERGENNJ07047 DISQUALIFICATION5/20/1999AC HOME NURSING 12352306652921 YOUNGSTOWN ROADWARRENOH44484 DISQUALIFICATION11/20/2015 ACKLEY, GEORGEPSYCH5/13/19441457535833202 LENOX AVENUECAPE MAYNJ08204 DEBARMENT7/21/2015 ACOSTA, LEILANICHHA4/14/1977458 STEVENSON PLACE, 1ST FLPERTH AMBOYNJ08861 DISQUALIFICATION5/9/2019 ACOSTA, PEDRO 43RD AVENUEWOODSIDENY11377 SUSPENSION4/13/2008 ACOSTA.

4 PEDRO 43RD AVENUEWOODSIDENY11377 DISQUALIFICATION5/2/2008 State of New Jersey Medicaid Fraud DivisionProvider Exclusion Report**ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**2 Updated on: 5/2/2022 For verifications please contact: an email to to receive this report in .xls formatPROVIDER NAMETITLEDATE OF BIRTHNPI NUMBERSTREETCITYSTATEZIPACTIONEFFECTIVE DATEEXPIRATION DATEACOSTA, PEDRO 43RD AVENUE, 1ST FLOORWOODSIDENY11377 DISQUALIFICATION9/16/2011 ACOSTA, WILLIAM OSBORNE STREETJOHNSTOWNPA15905 DISQUALIFICATION11/20/2015 ACQUAH, ROSE AKA MANFORD, ROSECHHA10/1/19845507 WARNER VIEW LANEWESTVILLEOH43081 DEBARMENT7/13/2018 ACQUAIRE, FLORENCE7/4/1940 EMCF PO BOX 08809 CLINTONNJ08809 SUSPENSION4/20/2006 ACQUAYE, EDWARD2/9/195010 BERWICK CIRCLENORTH BRUNSWICKNJ08902 SUSPENSION4/19/2007 ACZON, FERDINAND B.

5 MD11/29/19481255422135204 SUMMIT ROADMOUNT LAURELNJ08054 DISQUALIFICATION9/20/201111/23/2016 ADADEVOH, LOVESDALE AKA HAMENOO, LOVESDALECHHA12/10/19771 SKYTOP GARDENS, APT. 19 PARLINNJ08859 DISQUALIFICATION7/16/2019 ADAIR, LISA AKA TARASEVICH, LISALPN4/20/1961206 LAKEHURST AVENUE, APT. BNATIONAL PARKNJ08063 SUSPENSION9/19/2002 ADAMS, AMELIACHHA9/26/1994132 OAKMONT ROADCLEMENTONNJ08021 DISQUALIFICATION1/31/2017 ADAMS, ANTOINETTECHHA12/29/19761604 SEWALL AVENUEASBURY PARKNJ07712 DISQUALIFICATION1/31/2017 ADAMS, JAIME W. HAND AVENUECAPE MAY COURT HOUSENJ08210 SUSPENSION6/19/2003 ADAMSHICK, WILLIAM RPH10/9/196018718425752516 HURRY ROADFORKED RIVERNJ08731 SUSPENSION7/14/20053/21/2012 ADDIS, DAVID FARNSWORTH AVENUEBORDENTOWNNJ08505 DEBARMENT1/20/2015 PERMANENTADES, ALBERTMD1/11/195519120693943 MARKHAM CIRCLEENGLEWOODNJ07631 DEBARMENT5/16/2016 ADES, ALBERTMD1/11/19551912069394PO BOX 779800 MIAMIFL33177 DISQUALIFICATION12/12/2016 ADES, ALBERT (DR.)

6 'S OFFICE) 1447560867129 MADISON AVENUECRESSKILLNJ07626 DISQUALIFICATION6/16/2017 ADISSON, LECLERC MD8/14/19461482 SW 150TH TERRACESUNRISEFL33326 DISQUALIFICATION7/20/2007 PERMANENTADISSON, LUNICCHHA11/29/197114 WALTER PLACE #1 IRVINGTONNJ07111 DISQUALIFICATION3/14/2008 ADOLPHE, NAOMIECHHA8/24/1982410 FISHER AVENUENEPTUNENJ07753 DISQUALIFICATION2/20/2017 ADU-BOAHENE, KWABENACHHA2/19/19753 AUGUSTA DRIVELITTLE EGG HARBORNJ08087 DISQUALIFICATION1/23/2018 AFRIYIE, BRIGHTCHHA6/20/1994317 W. RUNYON STREET, 3 LNEWARKNJ07108 DISQUALIFICATION1/23/2018 AGARWAL, SHASHI CENTRAL AVENUE, 1ST FLEAST ORANGENJ07018 SUSPENSION10/22/2012 AGARWAL, SHASHI K.

7 MD6/15/19521558416099 FCI SCHUYLKILL, PO BOX 759 MINERSVILLEPA17954 DEBARMENT2/28/2014 State of New Jersey Medicaid Fraud DivisionProvider Exclusion Report**ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**3 Updated on: 5/2/2022 For verifications please contact: an email to to receive this report in .xls formatPROVIDER NAMETITLEDATE OF BIRTHNPI NUMBERSTREETCITYSTATEZIPACTIONEFFECTIVE DATEEXPIRATION DATEAGRAWAL, PANKAJ MD9/16/194919626612153 E. MEADOWBROOK CIRCLESICKLERVILLENJ08081 DISQUALIFICATION3/11/2006 AGRESTA JR., RUDOLPH BOX 7450 TRENTONNJ08628 SUSPENSION2/19/2004 AGRESTI, JAMESMD2/18/19701255389813/1477874352292 FAIRMONT ROADLONG VALLEYNJ07853 DEBARMENT10/5/2020 AGRESTI, ROBERTMD4/11/1957161915571015 BARBERRY WAYESSEX FALLSNJ07021 DISQUALIFICATION6/26/2018 AGUH, CHIKEZIEMD6/23/19561407876261/1619997483 18 MULBERRY COURTBELLE MEADNJ08502 DISQUALIFICATION2/11/2021 AGUIAR, SANDRA2/3/1967605 KNICKERBOCKER ROADTENAFLYNJ07670 DISQUALIFICATION6/18/2009 AGUILAR, RUBENRPH9/21/196216 GOLDENROD DRIVEBELLE MEADNJ08502 SUSPENSION7/20/2010 AGUIRRE-MEDRANO.

8 CANDIDA10/24/191540 FERRY STREETNEWARKNJ07105 DEBARMENT7/12/1999 AGYEMANG, JOHNRPH2/18/19691487934626153 BLUE MEADOW LANESICKLERVILLENJ08081 DISQUALIFICATION12/28/20169/22/2020 AGYEMANG, KWADWORPH3/8/1958115471339494 MARKET STREETNEWARKNJ07102 DEBARMENT8/25/20036/3/2015 AHLAWAT, RANVIRMD7/21/196414472046152204 ARVELL STREETTOMS RIVERNJ08755 DEBARMENT12/19/20169/14/2021 AHMAD, ABADULLAH4/3/1984280 LOUIS MARIN BOULEVARD #15 Jersey CITYNJ07302 SUSPENSION2/19/2009 AHMAD, FAROOQRPH10/1/19431659605590300 EAST HALSEY ROADPARSIPPANYNJ07054 SUSPENSION11/8/1994 AHMAD, NAEEM S682 BERGEN AVENUEJERSEY CITYNJ07306 DISQUALIFICATION9/15/1983 AHMAD, NAVEEDMD1/3/1950166941294648 SUYDAM ROADSOMERSETNJ08873 DISQUALIFICATION9/29/2016 PERMANENTAHMAD, NAVEEDMD1/3/1950166941294648 SUYDAM ROADSOMERSETNJ08873 DISQUALIFICATION12/20/2016 PERMANENTAHMED, AMIR TONNELLE AVENUE-2 MNJERSEY CITYNJ07306 SUSPENSION5/30/1997 AHMED, KHALID BOX 930 NEW YORKNY10013 DISQUALIFICATION3/26/1994 AHMED, MOHAMED TECH7/14/19895 WESTOVER TERRACEWEST ORANGENJ07052 DISQUALIFICATION8/20/2010 AIRD, EILEEN, GRANDVIEW CIRCLERIDGEWOOD NJ07450 SUSPENSION4/20/2003 AKANDE.

9 EZEKIELMD1/15/19591003859885300 HAIL KNOB ROAD, #290828 SOMERSETKY42503 DISQUALIFICATION9/20/2017 AKHMEDOV, KHUSEN8/1/1990 SCI GRATERFORD, ME9849, PO BOX 244 GRATERFORDPA19426 DISQUALIFICATION11/20/2015 AKHTAR, NADEEMRPH12/16/1959106369596315 GRIST MILL LANEUPPER SADDLE RIVERNJ07458 DEBARMENT1/20/2012 State of New Jersey Medicaid Fraud DivisionProvider Exclusion Report**ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**4 Updated on: 5/2/2022 For verifications please contact: an email to to receive this report in .xls formatPROVIDER NAMETITLEDATE OF BIRTHNPI NUMBERSTREETCITYSTATEZIPACTIONEFFECTIVE DATEEXPIRATION DATEAKHTAR, NADEEM RPH12/16/1959106369596315 GRIST MILL LANEUPPER SADDLE RIVERNJ07458 DISQUALIFICATION9/20/2012 AKINBILE, MORUFU E.

10 MOOREHAVEN DRIVECARSONCA90746 DISQUALIFICATION8/20/2010AL SALIHI, FAROUKMD7/1/193417201580251810 JOHN F. KENNEDY BOULEVARDJERSEY CITYNJ07305 SUSPENSION5/1/2011AL SALIHI, FAROUK MD7/1/193417201580251810 JOHN F. KENNEDY BOULEVARDJERSEY CITYNJ07305 DEBARMENT1/9/2015 ALAMEEN, ALWALEEDTEMPT TRANS5/16/1968238 MAIN STREETHACKENSACKNJ07601 SUSPENSION7/18/1995 ALAN, DAVIDOD7/26/19461225012073203 NORTH REDWOOD STREETMASONTOWNPA15461 DISQUALIFICATION11/20/2015 ALBERS, HENRY QUEEN STREETPARSIPPANYNJ07054 DISQUALIFICATION1/9/1996 ALBINO, ETHANRN3/4/1989224 FERN AVENUEHADDON TOWNSHIPNJ08108 DISQUALIFICATION9/7/2017 ALCAIDE, KELLEYLPN2/4/1969716 RIVER ROADSOMERVILLENJ08844 SUSPENSION2/20/2002 ALEXANDER, EDWARD J.