State of New Jersey Medicaid Fraud Division Provider Exclusion Report

Home , 14th Street (Hoboken), Alexandria, Aristides (horse), Audubon Avenue, Boulevard East, Carline

State of New Jersey 1 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE 2258 PHARMACY, INC. 2258 THIRD AVENUE NEW YORK NY 10035 SUSPENSION 7/20/2003 6522 VENTNOR AVE. 6522 VENTNOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION PHARMACY, INC. ABARCA, CHERYL R. LPN 8/15/1962 528 3RD STREET NEWARK NJ 07107 SUSPENSION 6/20/2005 ABASHKIN, ROMAN CHHA 12/21/1981 72 RIDGEVIEW TERRACE WAYNE NJ 07470 DISQUALIFICATION 5/29/2015 ABASHKIN, ROMAN CHHA 12/21/1981 72 RIDGEVIEW TERRACE WAYNE NJ 07470 DISQUALIFICATION 6/3/2016 ABBASSI, JADAN MD 9/19/1944 1194807255 1618 MAIN AVENUE CLIFTON NJ 07011 DISQUALIFICATION 11/21/2016 PERMANENT ABBASSI, JADAN MD 9/19/1944 1194807255 115 NELLIS DRIVE WAYNE NJ 07470 DISQUALIFICATION 6/20/2018 PERMANENT ABDALLA, IZZELDIN 4/5/1967 1116 ANNE STREET ELIZABETH NJ 07201 DISQUALIFICATION 11/10/1999 ABDELGANI, AMIR ALLENWOOD USP WHITE DEER PA 17887 DISQUALIFICATION 11/26/2001 ABDELGANI, FADIL TERRE HAUTE USP TERRE HAUTE IN 47808 DISQUALIFICATION 11/26/2001 ABDELHAMID, MANAL RPH 5/28/1969 7100 BOULEVARD EAST, 11G GUTTENBERG NJ 07093 DEBARMENT 3/15/2001

ABDOLLAHI, MITRA DMD 8/31/1966 1033329230 646 N. SARATOGA DRIVE MOORESTOWN NJ 08057 DISQUALIFICATION 11/5/2007 7/19/2019 ABERBACH, STEVEN RPH 8/5/1944 23 STONEGATE DRIVE WATCHUNG NJ 07069 DEBARMENT 12/19/2003 ABOOD, ABDOLMAID S. 1/20/1966 64 BEVAN STREET JERSEY CITY NJ 07306 SUSPENSION 5/7/1997 ABOODS MEDICAL LIVERY 64 BEVAN STREET JERSEY CITY NJ 07306 DISQUALIFICATION 5/22/1994

ABOUELHODA, AHMED RPH 3/23/1974 33-17 60TH STREET, APT. 1 WOODSIDE NY 11377 SUSPENSION 9/20/2005 ABRAHAMSEN, SVEND DPM 9/17/1944 101 CHESTNUT RIDGE ROAD SADDLE RIVER NJ 07458 DISQUALIFICATION 4/20/1994

ABRAMS, DE'NYSHIA CHHA 11/16/1993 410 3RD AVENUE, APT. 1A ASBURY PARK NJ 07712 DISQUALIFICATION 7/16/2018 ABRAMS, IRVING RPH 12/23/1949 5 LORENE WAY MORGANVILLE NJ 07551 SUSPENSION 4/27/2000 ABREU MARTINEZ, CHHA 12/14/1989 14 EAST RUSSELL STREET CLIFTON NJ 07011 DEBARMENT 10/31/2017 ABUSEF, ELSAYED K. SUTEX 814 74TH STREET NORTH BERGEN NJ 07047 DISQUALIFICATION 5/20/1999 MED. TRANSP ORT AC HOME NURSING 1235230665 2921 YOUNGSTOWN ROAD WARREN OH 44484 DISQUALIFICATION 11/20/2015 ACKLEY, GEORGE PSYCH 5/13/1944 1457535833 202 LENOX AVENUE CAPE MAY NJ 08204 DEBARMENT 7/21/2015 ACOSTA, LEILANI CHHA 4/14/1977 458 STEVENSON PLACE, 1ST PERTH AMBOY NJ 08861 DISQUALIFICATION 5/9/2019 FL ACOSTA, PEDRO E. 1/23/1945 5815 43RD AVENUE WOODSIDE NY 11377 SUSPENSION 4/13/2008

For verifications please contact: [email protected] Send an email to [email protected] to receive this report in .xls format State of New Jersey 2 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ACOSTA, PEDRO E. 1/23/1945 5815 43RD AVENUE WOODSIDE NY 11377 DISQUALIFICATION 5/2/2008 ACOSTA, PEDRO E. 1/23/1945 5815 43RD AVENUE, 1ST WOODSIDE NY 11377 DISQUALIFICATION 9/16/2011 FLOOR ACOSTA, WILLIAM R. MD 8/24/1949 47 OSBORNE STREET JOHNSTOWN PA 15905 DISQUALIFICATION 11/20/2015 ACQUAH, ROSE AKA CHHA 10/1/1984 5507 WARNER VIEW LANE WESTVILLE OH 43081 DEBARMENT 7/13/2018 MANFORD, ROSE ACQUAIRE, FLORENCE 7/4/1940 EMCF PO BOX 08809 CLINTON NJ 08809 SUSPENSION 4/20/2006 ACQUAYE, EDWARD 2/9/1950 10 BERWICK CIRCLE NORTH BRUNSWICK NJ 08902 SUSPENSION 4/19/2007 ACZON, FERDINAND B. MD 11/29/1948 1255422135 204 SUMMIT ROAD MOUNT LAUREL NJ 08054 DISQUALIFICATION 9/20/2011 11/23/2016 ADADEVOH, LOVESDALE CHHA 12/10/1977 1 SKYTOP GARDENS, APT. 19 PARLIN NJ 08859 DISQUALIFICATION 7/16/2019 AKA HAMENOO, LOVESDALE ADAIR, LISA AKA LPN 4/20/1961 206 LAKEHURST AVENUE, NATIONAL PARK NJ 08063 SUSPENSION 9/19/2002 TARASEVICH, LISA APT. B ADAMS, AMELIA CHHA 9/26/1994 132 OAKMONT ROAD CLEMENTON NJ 08021 DISQUALIFICATION 1/31/2017 ADAMS, ANTOINETTE CHHA 12/29/1976 1604 SEWALL AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 1/31/2017 ADAMS, JAIME L. CHHA 4/15/1976 911 W. HAND AVENUE CAPE MAY COURT NJ 08210 SUSPENSION 6/19/2003 HOUSE ADAMSHICK, WILLIAM RPH 10/9/1960 1871842575 2516 HURRY ROAD FORKED RIVER NJ 08731 SUSPENSION 7/14/2005 3/21/2012 ADDIS, DAVID J. MD 8/10/1944 1770656068 334 FARNSWORTH AVENUE BORDENTOWN NJ 08505 DEBARMENT 1/20/2015 PERMANENT ADES, ALBERT MD 1/11/1955 1912069394 3 MARKHAM CIRCLE ENGLEWOOD NJ 07631 DEBARMENT 5/16/2016 ADES, ALBERT MD 1/11/1955 1912069394 PO BOX 779800 MIAMI FL 33177 DISQUALIFICATION 12/12/2016 ADES, ALBERT (DR.'S 1447560867 129 MADISON AVENUE CRESSKILL NJ 07626 DISQUALIFICATION 6/16/2017 OFFICE) ADISSON, LECLERC MD 8/14/1946 1482 SW 150TH TERRACE SUNRISE FL 33326 DISQUALIFICATION 7/20/2007 PERMANENT ADISSON, LUNIC CHHA 11/29/1971 14 WALTER PLACE #1 IRVINGTON NJ 07111 DISQUALIFICATION 3/14/2008 ADOLPHE, NAOMIE CHHA 8/24/1982 410 FISHER AVENUE NEPTUNE NJ 07753 DISQUALIFICATION 2/20/2017 ADU-BOAHENE, CHHA 2/19/1975 3 AUGUSTA DRIVE LITTLE EGG HARBOR NJ 08087 DISQUALIFICATION 1/23/2018 KWABENA AFRIYIE, BRIGHT CHHA 6/20/1994 317 W. RUNYON STREET, 3L NEWARK NJ 07108 DISQUALIFICATION 1/23/2018

AGARWAL, SHASHI K. MD 6/15/1952 1558416099 198 CENTRAL AVENUE, 1ST EAST ORANGE NJ 07018 SUSPENSION 10/22/2012 FL

For verifications please contact: [email protected] Send an email to [email protected] to receive this report in .xls format State of New Jersey 3 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE AGARWAL, SHASHI K. MD 6/15/1952 1558416099 FCI SCHUYLKILL, PO BOX 759 MINERSVILLE PA 17954 DEBARMENT 2/28/2014

AGRAWAL, PANKAJ MD 9/16/1949 1962661215 3 E. MEADOWBROOK CIRCLE SICKLERVILLE NJ 08081 DISQUALIFICATION 3/11/2006

AGRESTA JR., RUDOLPH G. MD 8/18/1954 PO BOX 7450 TRENTON NJ 08628 SUSPENSION 2/19/2004 AGRESTI, JAMES MD 2/18/1970 1255389813/ 292 FAIRMONT ROAD LONG VALLEY NJ 07853 DEBARMENT 10/5/2020 1477874352 AGRESTI, ROBERT MD 4/11/1957 1619155710 15 BARBERRY WAY ESSEX FALLS NJ 07021 DISQUALIFICATION 6/26/2018 AGUH, CHIKEZIE MD 6/23/1956 1407876261/ 18 MULBERRY COURT BELLE MEAD NJ 08502 DISQUALIFICATION 2/11/2021 1619997483 AGUIAR, SANDRA 2/3/1967 605 KNICKERBOCKER ROAD TENAFLY NJ 07670 DISQUALIFICATION 6/18/2009

AGUILAR, RUBEN RPH 9/21/1962 16 GOLDENROD DRIVE BELLE MEAD NJ 08502 SUSPENSION 7/20/2010 AGUIRRE-MEDRANO, 10/24/1915 40 FERRY STREET NEWARK NJ 07105 DEBARMENT 7/12/1999 CANDIDA AGYEMANG, JOHN RPH 2/18/1969 1487934626 153 BLUE MEADOW LANE SICKLERVILLE NJ 08081 DISQUALIFICATION 12/28/2016 9/22/2020 AGYEMANG, KWADWO RPH 3/8/1958 1154713394 94 MARKET STREET NEWARK NJ 07102 DEBARMENT 8/25/2003 6/3/2015 AHLAWAT, RANVIR MD 7/21/1964 1447204615 2204 ARVELL STREET TOMS RIVER NJ 08755 DEBARMENT 12/19/2016 AHMAD, ABADULLAH 4/3/1984 280 LOUIS MARIN JERSEY CITY NJ 07302 SUSPENSION 2/19/2009 BOULEVARD #15 AHMAD, FAROOQ RPH 10/1/1943 1659605590 300 EAST HALSEY ROAD PARSIPPANY NJ 07054 SUSPENSION 11/8/1994 AHMAD, NAEEM S 682 BERGEN AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 9/15/1983 AHMAD, NAVEED MD 1/3/1950 1669412946 48 SUYDAM ROAD SOMERSET NJ 08873 DISQUALIFICATION 9/29/2016 PERMANENT AHMAD, NAVEED MD 1/3/1950 1669412946 48 SUYDAM ROAD SOMERSET NJ 08873 DISQUALIFICATION 12/20/2016 PERMANENT AHMED, AMIR E. 1/1/1962 7-11 TONNELLE AVENUE- JERSEY CITY NJ 07306 SUSPENSION 5/30/1997 2MN AHMED, KHALID H. 2/6/1963 PO BOX 930 NEW YORK NY 10013 DISQUALIFICATION 3/26/1994 AHMED, MOHAMED G. PHARM 7/14/1989 5 WESTOVER TERRACE WEST ORANGE NJ 07052 DISQUALIFICATION 8/20/2010 TECH AIRD, EILEEN, B. 6/28/1950 295 GRANDVIEW CIRCLE RIDGEWOOD NJ 07450 SUSPENSION 4/20/2003 AKANDE, EZEKIEL MD 1/15/1959 1003859885 300 HAIL KNOB ROAD, SOMERSET KY 42503 DISQUALIFICATION 9/20/2017 #290828

For verifications please contact: [email protected] Send an email to [email protected] to receive this report in .xls format State of New Jersey 4 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE AKHMEDOV, KHUSEN 8/1/1990 SCI GRATERFORD, ME9849, GRATERFORD PA 19426 DISQUALIFICATION 11/20/2015 PO BOX 244 AKHTAR, NADEEM RPH 12/16/1959 1063695963 15 GRIST MILL LANE UPPER SADDLE RIVER NJ 07458 DEBARMENT 1/20/2012

AKHTAR, NADEEM RPH 12/16/1959 1063695963 15 GRIST MILL LANE UPPER SADDLE RIVER NJ 07458 DISQUALIFICATION 9/20/2012

AKINBILE, MORUFU O. RN 5/1/1966 419 E. MOOREHAVEN DRIVE CARSON CA 90746 DISQUALIFICATION 8/20/2010

AL SALIHI, FAROUK MD 7/1/1934 1720158025 1810 JOHN F. KENNEDY JERSEY CITY NJ 07305 SUSPENSION 5/1/2011 BOULEVARD AL SALIHI, FAROUK MD 7/1/1934 1720158025 1810 JOHN F. KENNEDY JERSEY CITY NJ 07305 DEBARMENT 1/9/2015 BOULEVARD ALAMEEN, ALWALEED TEMPT 5/16/1968 238 MAIN STREET HACKENSACK NJ 07601 SUSPENSION 7/18/1995 TRANS ALAN, DAVID OD 7/26/1946 1225012073 203 NORTH REDWOOD MASONTOWN PA 15461 DISQUALIFICATION 11/20/2015 STREET ALBERS, HENRY J. EMT 8/22/1944 3 QUEEN STREET PARSIPPANY NJ 07054 DISQUALIFICATION 1/9/1996 ALBINO, ETHAN RN 3/4/1989 224 FERN AVENUE HADDON TOWNSHIP NJ 08108 DISQUALIFICATION 9/7/2017 ALCAIDE, KELLEY LPN 2/4/1969 716 RIVER ROAD SOMERVILLE NJ 08844 SUSPENSION 2/20/2002 ALEXANDER, EDWARD J. MD 6/4/1955 8001 CASTOR AVENUE, SUITE PHILADELPHIA PA 19152 DEBARMENT 8/8/2000 326 ALEXANDER, JULIE B. RPH 8/20/1972 1525 DOGWOOD DRIVE CHERRY HILL NJ 08003 SUSPENSION 5/19/2005 ALEXANDRA, ALYCIA AKA RN 5/9/1975 6 LOWELL ROAD MANALAPAN NJ 07726 DISQUALIFICATION 11/23/2019 DOTRO, ALYCIA ALFONSO, NORMA CHHA 5/21/1948 144 SUMMIT STREET ENGLEWOOD NJ 07631 SUSPENSION 8/19/1997 AL-GHRAOUI, FADI MD 4/9/1955 PO BOX 23429 FORT LAUDERDALE FL 33307 DISQUALIFICATION 11/18/2004 DECEASED ALI, HANIFAH CHHA 12/3/1990 1216 FALCON DRIVE ABSECON NJ 08201 DISQUALIFICATION 2/20/2017 ALI, MOHAMED T. 4/18/1954 64 BEVAN STREET JERSEY CITY NJ 07306 DISQUALIFICATION 5/31/1994 ALI, RAUSHANAH LPN 12/26/1980 103 BONNIA AVENUE TRENTON NJ 08629 DISQUALIFICATION 8/3/2019 ALI, SAQIB 3/14/1954 MDC BROOKLYN, PO BOX BROOKLYN NY 11232 DEBARMENT 5/20/2012 3290 ALI, TARIK TARK 566 BLOOMFIELD AVENUE BLOOMFIELD NJ 07306 DISQUALIFICATION 5/10/1999 TRANS

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ALLEN, ADINA CHHA 8/21/1979 219 PINEBROOK DRIVE MANTUA NJ 08051 DISQUALIFICATION 5/22/2017 ALLEN, DEBRA CHHA 7/9/1961 18 REID LANE MILLSTONE NJ 08535 DISQUALIFICATION 9/6/2019 PERMANENT TOWNSHIP ALLEN, KENNYATTA G. 1/14/1976 148 CORNERSTONE PLACE WHITEHALL PA 18052 DISQUALIFICATION 3/14/2008 ALLEN-BROGAN, MELANIE 8/1/1984 135 WILD OAKS COURT LITTLE EGG HARBOR NJ 08701 SUSPENSION 3/5/2008 A. ALLIED CLINICAL LAB, INC. 5199 S. GREEN STREET SALT LAKE CITY UT 84123 DISQUALIFICATION 6/18/1997 ALLIED CLINICAL LAB, INC. 863 MCCALLIE AVENUE CHATTANOOGA TN DISQUALIFICATION 6/18/1997 ALLRED, ELLEN ANNE RN 3/11/1975 571 FERNWOOD LANE FAIRLESS HILLS PA 19030 DISQUALIFICATION 11/20/2015 ALLSTATE AMBULANCE PO BOX 1011 UNION NJ 07083 DISQUALIFICATION 4/3/2000 CORPORATION ALPERIN, MARTIN MD 8/20/1927 28 RIVERSIDE AVENUE RED BANK NJ 07701 DEBARMENT 6/19/2000 ALPERT, PERRY DDS 8/4/1941 1952668782 560 NEWARK AVENUE ELIZABETH NJ 07208 SUSPENSION 10/2/1995 8/26/2020 ALSTON, SHERRELLE 12/11/1970 NORTH 52ND STREET PHILADELPHIA PA 19139 DEBARMENT 10/9/2007 ALTOONIAN, ANN MARIE RN 6/29/1966 82 CONTANT AVENUE, APT. 2 LODI NJ 07644 DISQUALIFICATION 5/11/2019

ALVIS, SANDRA CHHA 5/29/1955 1421 HOLLINSHED AVENUE PENNSAUKEN NJ 08110 SUSPENSION 5/19/2005 ALY, ABUBAKR CRESCEN 5/26/1955 24 BRANFORD PLACE NEWARK NJ 07102 DISQUALIFICATION 3/11/2004 T TRANS

ALY, AHMED F. RPH 4/16/1974 1030 LIBERTY AVENUE UNION NJ 07083 SUSPENSION 8/17/2007 ALY, WAEL 10/30/1966 1137 MAIN AVENUE CLIFTON NJ 07011 SUSPENSION 5/30/2000 AMABILE, JOHN C. OD 4/23/1962 HIGHWAY #35 & 3RD OCEAN NJ 07712 DISQUALIFICATION 6/30/2002 AVENUE AMAKER, PHYLLIS CHHA 3/25/1960 475 LIVINGSTON DRIVE EAST WINDSOR NJ 08520 DISQUALIFICATION 1/31/2017 AMANKWAH, VINCENTIA 11/4/1978 8 MAPLES AVENUE CLIFFWOOD NJ 07721 DEBARMENT 5/1/2016

AMANKWAH, VINCENTIA 11/4/1978 8 MAPLES AVENUE CLIFFWOOD NJ 07721 DISQUALIFICATION 3/28/2017

AMATO, CARLO DC 7/3/1961 1275673360 500 RIVER AVENUE LAKEWOOD NJ 08701 DISQUALIFICATION 9/18/2018 AMATO, NICOLA DC 3/1/1963 1366941627 3 MULLIGAN DRIVE FLANDERS NJ 07836 SUSPENSION 6/20/2005 AMATO, STEVEN P. DC 8/1/1955 30151 FISH ROCK ROAD YORKVILLE CA 95494 DISQUALIFICATION 10/20/2009

For verifications please contact: [email protected] Send an email to [email protected] to receive this report in .xls format State of New Jersey 6 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE AMATO, VANESSA A. AKA RN 3/21/1977 65 LOCUST AVENUE NORTH ARLINGTON NJ 07031 SUSPENSION 9/19/2003 NOWINSKI, VANESSA

AMBROSE, DEAN A. DO 6/18/1957 1598832560 119 NORTH CENTRE STREET MERCHANTVILLE NJ 08109 DEBARMENT 2/1/2002

AMENYITOR, APEAFA CHHA 3/9/1987 14 MARSHALL STREET, APT. IRVINGTON NJ 07111 DISQUALIFICATION 2/20/2017 14W AMERICAN EXPRESS 1386883239 13420 DAMAR DRIVE, SUITE PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015 LOAN, INC. C AMERICAN MED. TECH., 1072 MADISON AVENUE LAKEWOOD NJ SUSPENSION 4/14/1999 INC. AMERICAN MEDICAL 1205071883 PO BOX 3093 WARMINSTER PA 18974 DISQUALIFICATION 11/20/2015 EXPRESS AMBULANCE, LLC. AMES, TRISHEENA CHHA 5/5/1991 96 HALSEY REED ROAD CRANBURY NJ 08512 DISQUALIFICATION 6/28/2018 AMIN, PRISCILLA CHHA 6/18/1990 133 ATLANTIC STREET HACKENSACK NJ 07601 DEBARMENT 10/23/2017 AMON, TAMERLANE CNA 8/8/1979 394 EGE AVENUE JERSEY CITY NJ 07304 DISQUALIFICATION 7/16/2018 AMON, TAMERLANE CNA 8/8/1979 394 EGE AVENUE JERSEY CITY NJ 07304 DISQUALIFICATION 5/18/2019 AMPARO, VIANNE AKA CHHA 10/2/1982 710 EAST 18TH STREET PATERSON NJ 07501 DISQUALIFICATION 1/31/2017 PAYANO, VIANNE AMPOFO, TWUMASI 6/3/1968 12 MARSHALL STREET #7W IRVINGTON NJ 07111 SUSPENSION 2/1/2008 AMPOFO, TWUMASI 6/3/1968 12 MARSHALL STREET #7W IRVINGTON NJ 07111 DISQUALIFICATION 3/30/2009 ANAND, NEIL MD 3/15/1977 1982626818 26 TAFT LANE MORRISTOWN NJ 07960 DISQUALIFICATION 12/18/2019 ANAND, SUBINA DMD 8/30/1967 1982781589 17 GROVERS MILL ROAD PLAINSBORO NJ 08536 DISQUALIFICATION 12/20/2012 ANAND, SUBINA DMD 8/30/1967 1982781589 17 GROVERS MILL ROAD PLAINSBORO NJ 08536 DISQUALIFICATION 4/17/2012 ANDAS 592 PALISADE AVENUE TEANECK NJ 07666 DISQUALIFICATION 5/20/2018 PHARMACEUTICAL SUPPLY CORP. ANDERSON, CHARMAINE RN 10/16/1973 95 FARRAGUT ROAD NORTH PLAINFIELD NJ 07062 DISQUALIFICATION 6/28/2017

ANDERSON, DAVID RN 4/3/1951 519 HOBART AVENUE TRENTON NJ 08629 SUSPENSION 10/20/2003 ANDERSON, FRANCINE CHHA 7/6/1967 901 PRINCETON AVENUE LAKEWOOD NJ 08701 DISQUALIFICATION 2/12/2018 ANDERSON, JOHN P. MD 8/25/1926 362 S. LAUREL STREET WAYNEBORO VA 22980 SUSPENSION 1/20/1999

For verifications please contact: [email protected] Send an email to [email protected] to receive this report in .xls format State of New Jersey 7 Medicaid Fraud Division Provider Exclusion Report Updated on: 8/23/2021 **ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ANDERSON, NICOLE RN 8/27/1986 1801 HUNTINTON MEWS CLEMONTON NJ 08021 DISQUALIFICATION 8/28/2017 ANDRADE, GLORIA LCSW/LC 9/18/1962 1992804850 679 GRANT TERRACE TEANECK NJ 07666 SUSPENSION 6/18/2018 ADC ANDREWS, TANELLE RN 8/16/1979 1340 S. ORCHARD ROAD VINELAND NJ 08360 DISQUALIFICATION 5/25/2019 ANDUJAR, EDWARD MD 12/23/1955 516 E. WOOD STREET VINELAND NJ 07410 DISQUALIFICATION 1/20/2006 ANELLO, ALLYSON PHARM 9/30/1984 708 FOX HILL DRIVE DOVER NJ 07801 DISQUALIFICATION 2/5/2018 PERMANENT TECH ANEROUSIS, MARY DEE DDS 11/26/1965 1871675769 383 SOUTH ORANGE AVENUE LIVINGSTON NJ 07039 DISQUALIFICATION 5/20/2019

ANGEL, CHRISTINA CHHA 5/9/1989 145 PRESIDENTIAL PATERSON NJ 07522 DISQUALIFICATION 2/20/2017 BOULEVARD, APT. 16J ANGELES, KATHERINE MD 4/6/1958 191 ROUTE 37 WEST TOMS RIVER NJ 08755 DEBARMENT 6/23/1995 DECEASED ANGELO, JOSEPH 3/9/1949 34 STONEHEDGE ROAD LINCROFT NJ 07738 DISQUALIFICATION 4/27/1993 ANODIDE, PAUL A. DDS 2/4/1956 1841317625 23 BLUE DEVIL LANE TRENTON NJ 08619 DISQUALIFICATION 2/3/2006 ANSERE, PATIENCE CHHA 305 COOLIDGE AVENUE ENGLEWOOD NJ 07631 DISQUALIFICATION 7/17/2018 ANTELL, CLIFF 12/26/1974 FCI CUMBERLAND, PO BOX CUMBERLAND MD 21501 DISQUALIFICATION 5/18/2019 1000 ANTHONY, QUINT LPN 4/7/1956 900 BARNEGAT BOULEVARD BARNEGAT NJ 08005 DISQUALIFICATION 6/5/2017 N #908 ANTONE, JULIE LCSW 8/9/1980 366 CAMBRIDGE DRIVE RAMSEY NJ 07446 DEBARMENT 2/20/2013 ANTWI, ISAAC CHHA 6/28/1983 549 BOLTON AVENUE #1 BRONX NY 10473 DEBARMENT 6/28/2018 ANZALONE, ANTHONY MD 9/23/1952 1124071857 203 DIETZ STREET CRANFORD NJ 07016 DISQUALIFICATION 2/8/2019 PERMANENT APONTE, DENNIS MD 9/23/1966 1053458018 MDC BROOKLYN, PO BOX BROOKLYN NY 11232 DISQUALIFICATION 5/20/2015 329002 AQUILANTE, JOHN C. RPH 8/13/1946 27 ROCKLEDGE PLACE CEDAR GROVE NJ 07009 DISQUALIFICATION 9/23/1983 DECEASED ARDAN, MARGO RN 8/5/1963 161 CONAWAGA TRAIL MEDFORD NJ 08055 DISQUALIFICATION 6/28/2017 ARDEHALI, MOHAMMAD MD 12/19/1944 193 ELWOOD AVENUE NEWARK NJ 07104 SUSPENSION 2/20/2001

ARGUETA, ALVARO MD 4/13/1942 1194851618 9408 BIG VIEW DRIVE AUSTIN TX 78730 DISQUALIFICATION 7/22/2017 PERMANENT ARGUETA, EDWARD A. CNA 4/13/1972 604 N. BAYVIEW AVENUE SEASIDE PARK NJ 08752 SUSPENSION 4/8/1999 ARGUETA, EDWARD A. CNA 4/13/1972 604 N. BAYVIEW AVENUE SEASIDE PARK NJ 08752 SUSPENSION 9/13/1999 ARIF, MOHAMMED 4/5/1965 147-14 14TH AVENUE WHITESTONE NY 11375 DISQUALIFICATION 12/1/1998 ARMBRISTER, KATIMA CHHA 4/12/1973 301 BELMAR AVENUE NEPTUNE NJ 07753 DISQUALIFICATION 2/20/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ARNESON, VICTORIA RN 4/1/1969 42 HOLLY STREET CRANFORD NJ 07016 SUSPENSION 9/19/2003 AROWOSAYE, EMILY RN 5/12/1967 24 CUNNINGHAM DRIVE WEST ORANGE NJ 07052 DISQUALIFICATION 7/31/2010 AROWOSAYE, EMILY RN 5/12/1967 24 CUNNINGHAM DRIVE WEST ORANGE NJ 07052 DEBARMENT 5/20/2012 AROWOSAYE, ISAAC 10/8/1956 24 CUNNINGHAM DRIVE WEST ORANGE NJ 07052 DEBARMENT 3/30/2010 AROWOSAYE, ISAAC 10/8/1956 24 CUNNINGHAM DRIVE WEST ORANGE NJ 07052 DEBARMENT 7/4/2014 ASHOKAN, ANNAMALAI MD 7/6/1953 1497857270 7 ROCKLEDGE DRIVE SUFFERN NY 10901 DEBARMENT 5/1/2004 ASKANAZI, JEFFREY MD 3/23/1951 2322 OLDE FARM LANE HUDSON OH 44236 DEBARMENT 7/19/1999 ASLAM, ZAHID MD 9/3/1972 1306906854 1814 E. 2ND STREET SCOTCH PLAINS NJ 07076 DISQUALIFICATION 1/16/2019 PERMANENT ASTON, ALEXIA L. LPN 2/12/1980 15 PRIMROSE LANE, APT. 3 DELRAN NJ 08075 DISQUALIFICATION 6/18/2009 ASTORE, MARYANN CHHA 9/3/1961 45 KOHOMO AVENUE ERIAL NJ 08081 DEBARMENT 4/30/2019 ATIENZA, CESAR P. MD 12/12/1943 1164491494 56 COLD INDIAN SPRING OCEAN NJ 07712 DISQUALIFICATION 8/6/1991 ROAD ATKINS, DAWN AKA STILL, CHHA 9/17/1988 697 EVERETT STREET CAMDEN NJ 08104 DISQUALIFICATION 3/6/2018 DAWN AUFSEESER, LESLIE DPM 10/21/1948 1164410742 11 MEADOWS LANE WAYSIDE NJ 07712 DEBARMENT 2/12/2018 AUSTIN, BRITTANY CHHA 11/11/1992 420 N. SOUTH CAROLINA ATLANTIC CITY NJ 08401 DISQUALIFICATION 6/6/2018 AVENUE AUSTIN, DONALD P 3/3/1960 31 MADISON AVENUE MONTCLAIR NJ 07042 DISQUALIFICATION 6/1/1993 AUSTIN, NIDERIA CHHA 8/5/1994 822 GALINDEZ COURT CAMDEN NJ 08102 DISQUALIFICATION 12/15/2017 AVILES, REBECCA CHHA 2/6/1988 67 MILL ROAD LEVITTOWN PA 19057 DISQUALIFICATION 2/20/2017 AVON PHARMACY 300 MAIN STREET AVON NJ 07717 SUSPENSION 2/5/2003 AYALA, ANDRES 7/20/1954 33 MADISON AVENUE CHERRY HILL NJ 08002 SUSPENSION 9/11/2017 10/3/2019 AYALA, ANDRES 7/20/1954 33 MADISON AVENUE CHERRY HILL NJ 08002 DISQUALIFICATION 10/3/2019 AZAM, CHOWDHURY F. MD 7/1/1954 1922053792 38 ORIOLE DRIVE HACKETTSTOWN NJ 07840 DEBARMENT 2/1/1999 6/30/2015 AZAM, CHOWDHURY F. MD 7/1/1954 1922053792 30 DUNSTON LANE MONMOUTH NJ 08852 DEBARMENT 10/26/2016 JUNCTION AZIZ-DURRANI, 8/14/1948 328 SIP AVENUE JERSEY CITY NJ 07306 SUSPENSION 9/19/2002 AZU, PHILIP N. RPH 3/10/1957 2836 DEBRA WAY UNION NJ 07083 DISQUALIFICATION 5/20/1999 AZU, PHILIP N. RPH 3/10/1957 1094 CLINTON AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 4/19/2001 BABARIA, ASHOKKUMAR MD 2/23/1950 1538100599 FCI FORT DIX, PO BOX 2000 FORT DIX NJ 08640 DISQUALIFICATION 11/4/2014 R. BABARIA, ASHOKKUMAR MD 2/23/1950 1538100599 208 QUAKERBRIDGE COURT MOORESTOWN NJ 08057 SUSPENSION 1/10/2012 R.

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BABARIA, ASHOKKUMAR MD 2/23/1950 1538100599 5756 HARTFIELD/POINTVILLE FORT DIX NJ 08640 DISQUALIFICATION 2/28/2015 R. BABAYANTS, ALEXANDER MD 8/23/1955 1194779371 184 S. LIVINGSTON AVENUE LIVINGSTON NJ 07039 DEBARMENT 2/10/2018 #9272 BACSENKO, JENNIFER PHARM 3/18/1976 103 STATE STREET LINWOOD NJ 08221 SUSPENSION 1/20/2011 TECH BADAWY, BADAWY MD 12/27/1962 1679615553 2738 JOHN F. KENNEDY JERSEY CITY NJ 07306 DISQUALIFICATION 2/11/2016 BOULEVARD 1ST FL BADAWY, BADAWY MD 12/27/1962 1679615553 2738 JOH F. KENNEDY JERSEY CITY NJ 07306 SUSPENSION 3/25/2013 BOULEVARD 1ST FL BADO, JEFFREY DO 8/27/1955 1801908173 1615 ASHBOURNE ROAD ELKINS PARK PA 19027 DISQUALIFICATION 11/20/2015 BADO, JEFFREY #71927- DO 8/27/1955 1801908173 FDC PHILADELPHIA, PO BOX PHILADELPHIA PA 19105 DISQUALIFICATION 11/20/2017 066 562 BADUINI, JOLIE RN 6/26/1989 1300 32ND AVENUE SW, MINOT ND 58701 DISQUALIFICATION 5/20/2015 APT. 307 BAER, MICHAEL L. DC 6/12/1953 1053654616 BAYSIDE STATE PRISON, PO LEESBURG NJ 08327 SUSPENSION 9/20/2004 BOX F-1 BAEZ, ANNA DDS 3/6/1961 911 VILLAGE DRIVE SOMERSET NJ 08873 SUSPENSION 3/20/2002 BAFFOWAAH, ZIBORAH 12/15/1970 4345 DIAMOND DRIVE SAINT PAUL MN 55122 DISQUALIFICATION 2/20/2015 BAGDASAROVA, RN 7/17/1964 11981 AUDUBON AVENUE PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015 ANGELICA BAH, HUSAINATU RN/LPN 9/9/1988 2510 BIRCHWOOD COURT NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 1/15/2016 12/10/2019 BAH, HUSAINATU RN/LPN 9/9/1988 2510 BIRCHWOOD COURT NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 11/28/2013 12/10/2019 BAHNSON, WILLIAM F. MD 11/12/1927 28 HIGH STREET TREENFIELD MA 01301 DISQUALIFICATION 9/2/1988 DECEASED BAILEY, FREDERICK DDS 1/29/1960 1205048410 41 WEST GLEN ROAD DENVILLE NJ 07834 DISQUALIFICATION 9/29/2016 BAIRD, DAVID B. MD 5/11/1937 4107 MERCHANT SQUARE LANSDALE PA 19446 SUSPENSION 5/20/2004 PLACE BAJAKIAN, BRYAN DC 6/22/1959 1679618094 3105 STOWE LANE MAHWAH NJ 07430 DISQUALIFICATION 10/18/2010 BAJWA, LATIF AHMAD ACCUPU 5/7/1948 PO BOX 633 LANGHORNE PA 19047 SUSPENSION 2/9/2009 NCTURIS T BAKER, MONIQUE CHHA 12/24/1993 1521 NEWPORT STREET CAMDEN NJ 08104 DISQUALIFICATION 2/28/2019

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BAKER, SCOTT CNA 3/31/1972 215 BURLINGTON ROAD BRIDGETON NJ 08302 DISQUALIFICATION 5/24/2002 SOUTH BAKMAN, MILANA CHHA 9/28/1969 4 IVY WAY DAYTON NJ 08810 DEBARMENT 6/19/2018 BALLERAS, ALFREDO B. RPH 1/21/1972 1 VISTA DRIVE MOUNT OLIVE NJ 07836 DISQUALIFICATION 9/14/2010 9/13/2013 BAMDAD, BABAK RPH 8/21/1968 1285950642 2 SOUTH GATE ROAD, APT. GREAT NECK NY 11023 DISQUALIFICATION 7/26/2011 736 BAMDAD, BABAK RPH 8/21/1968 1285950642 333 RIVER STREET HOBOKEN NJ 07030 DEBARMENT 6/1/2010 BAMGBOYE, PATRICK DDS 1/1/1948 1720175508 358 MEISEL AVENUE SPRINGFIELD NJ 07081 DEBARMENT 11/7/2012 BANDY, ANHUAR 5/28/1963 141 CRINE ROAD COLTS NECK NJ 07722 DISQUALIFICATION 6/20/2018 BANDY, KARIM 2/27/1962 141 CRINE ROAD COLTS NECK NJ 07722 DISQUALIFICATION 6/20/2018 BANGOURA, ALPHA 1/1/1974 200 EXECUTIVE DRIVE WEST ORANGE NJ 07050 SUSPENSION 3/22/2006 BANKA, VIDYA MD 3/5/1941 1588659965 237 STACEY ROAD PENN VALLEY PA 19072 DISQUALIFICATION 3/19/2018 BANKS, KENNETH 5/13/1934 640 PINE STREET CAMDEN NJ 08103 DEBARMENT 8/14/2003 BAPTISTE, STANLEY CHHA 1/17/1992 401 WEST VIRGINIA AVENUE, NEPTINE NJ 07753 DISQUALIFICATION 4/19/2018 APT B-16 BARAHONA, RONY 8/9/1962 549 SUMMIT AVENUE MAPLEWOOD NJ 07040 DEBARMENT 3/26/2013 BARAN-DICRISCIO, CHHA 12/3/1939 309 IRIS ROAD CHERRY HILL NJ 08620 SUSPENSION 3/20/2002 LORRAINE BARAQUE, IVAN DARIO MD 1/31/1950 1811059967 4 WOODCREST COURT WEST NYACK NY 10994 DISQUALIFICATION 2/20/2015 BARASCH, MILTON RPH 1/15/1935 12 IVY WAY ABERDEEN NJ 07747 DEBARMENT 8/3/2000 DECEASED BARATTI, CARMEN DO 7/16/1934 150 KIRKBRIDGE ROAD VOORHEES NJ 08043 SUSPENSION 9/4/1997 BARBA, FIDELIS MD 4/25/1948 2 POWDER HILL SADDLE RIVER NJ 07458 DISQUALIFICATION 10/11/2000 BARBER-HINSON, CONNIE 1/4/1958 7011 SHADOW RUN SAN ANTONIO TX 78250 SUSPENSION 4/20/2011 BARBERS-WEBER, 12/10/1969 8 ELKRIDGE PARKWAY MANALAPAN NJ 07726 SUSPENSION 11/5/2009 JENNIFER BARDEN, BRENDA RN 7/5/1955 19 INTERVALE ROAD SALEM MA 01970 DISQUALIFICATION 12/20/2012 BARDO, MANUEL 6/19/1944 11756 SW 14TH TERRACE MIAMI FL SUSPENSION 8/19/2004 BARET, MICHELLE CHHA 6/4/1989 135 MARINA DRIVE EDISON NJ 06076 DISQUALIFICATION 2/8/2017 BARGE, NICHOLAS 6/7/1989 716 NAUTILUS STREET FORKED RIVER NJ 08731 DEBARMENT 3/16/2011 BARI, ABDUL 8/2/1954 264 PROSPECT STREET NUTLEY NJ 07110 DISQUALIFICATION 6/19/2009 BARIEXCA, CARLA LPN 12/14/1974 107 DAYTON STREET TRENTON NJ 08610 SUSPENSION 8/20/2006 BARNA, ARLENE RN 2/12/1936 205 KRAFT AVENUE OAKLYN NJ 08107 SUSPENSION 9/19/2003 BARNWELL, LATANYA 1/23/1984 1048 PENNINGTON ROAD EWING NJ 08618 DEBARMENT 9/16/2011 9/17/2014

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BARON, MICHAEL B. MD 2/27/1947 SE 1256 BISHOP BOULEVARD, PULMAN WA 99163 DEBARMENT 9/11/2000 STE 1 BARONE, THOMAS DO 1/22/1969 1780898965 255 17TH STREET, SUITE 601 PHILADELPHIA PA 19103 DISQUALIFICATION 11/20/2015

BARROUS, FELIPE EMT 9/6/1988 40 KNOLL TERRACE HAZLET NJ 07730 DISQUALIFICATION 2/28/2015 BARSH, LAUREN AKA RN 4/10/1982 9 FIELDCREST WAY HAZLET NJ 07730 DISQUALIFICATION 12/30/2019 MCCABE, LAUREN BARTLOW, BRIAN 3/3/1960 551 PARKWOOD AVENUE TOMS RIVER NJ 08753 SUSPENSION 7/17/2003 BAS, KONSTANTIN 10/4/1975 2800 COYLE STREET #625 BROOKLYN NY 11235 DISQUALIFICATION 9/14/2018 BASBUS, VIICTOR M. MD 7/18/1944 1811098858 33 5TH AVENUE, APT. 1B NEW YORK NY 10003 DEBARMENT 2/6/2009 BASCUS, NAOMI AKA RN 5/5/1975 6 ENGLISH IVY DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 12/26/2016 DERRICK, NAOMI BASCUS, NAOMI AKA RN 5/5/1975 6 ENGLISH IVY DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 4/9/2020 DERRICK, NAOMI BASSO, NICHOLAS V. MD 12/13/1945 7665 MAPLE AVENUE PENNSAUKEN NJ 08109 DEBARMENT 2/1/2000 BATARSEH, BASEL MD 5/12/1960 1063602696/ 620 FAIRLAWN AVENUE GLEN ROCK NJ 07410 DEBARMENT 12/31/2017 1891803318 BATARSEH, BASEL MD 5/12/1960 1063602696/ 85 VINCENT DRIVE CLIFTON NJ 07013 DISQUALIFICATION 8/20/2018 1891803318 BATEMAN, PAMELA LPN 6/19/1956 91 CHESTNUT STREET SALEM NJ 08079 SUSPENSION 7/21/2008 BATES, NANCY M. DO 9/10/1955 1043435209 38 PALSA AVENUE ELMWOOD PARK NJ 07407 DEBARMENT 4/3/2001 BATTLE, TIFANY CHHA 5/13/1981 393 IRVINE TURNER NEWARK NJ 07108 DISQUALIFICATION 2/20/2017 BOULEVARD, APT. 4D BAUBLITZ, CARRIE RN 6/2/1973 80 CONEWAGO DRIVE HANOVER PA 17331 DISQUALIFICATION 12/29/2015 BAUTISTA, FILOMENA CHHA 7/31/1946 133 PAMRAPO AVENUE #1 JERSEY CITY NJ 07305 DISQUALIFICATION 7/14/2017 BAXTER, LOUIS E. MD 3/17/1952 1962527051 2 MANCHESTER COURT COLUMBUS NJ 08022 DISQUALIFICATION 10/26/1983 4/2/2013 BEACHUM-THOMPSON, CHHA 1/11/1992 201 WEBSTER STREET WOODBINE NJ 08270 DISQUALIFICATION 1/17/2018 8/20/2018 AMY BEALS, PAUL V. MD 4/15/1943 1427175652 4120 WESTFIELD AVENUE PENNSAUKEN NJ 08110 SUSPENSION 6/24/2014 BEASLEY, BRANDI CNA 12/13/1995 433 ALFRED ROAD TOMS RIVER NJ 08757 DISQUALIFICATION 2/11/2019 PERMANENT BEAUCEJOUR, MONIQUE CHHA/C 8/5/1973 204 BERKELEY AVENUE, APT. BLOOMFIELD NJ 07003 DISQUALIFICATION 8/29/2019 NA 313 BECK, ALLAN G. MD 2/5/1944 1833 ARROWHEAD DRIVE WATERFORD NJ 08089 SUSPENSION 2/20/2001

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BECKETT, DONALD DPM 12/28/1948 1871692285 10144 DEERCLIFF DRIVE TAMPA FL 33647 DISQUALIFICATION 11/4/2005 BECKFORD, AUDREY L. 6/1/1968 566 NORTH MAPLE AVENUE EAST ORANGE NJ 07017 SUSPENSION 1/20/2002

BEDRICK, BERNARD A. 300 EAST 5 6TH STREET NEW YORK NY 10022 DISQUALIFICATION 6/1/1993 BEECHER, GEORGE MD 9/26/1940 1073574059 137 EVERGREEN AVENUE NW PROVIDENCE NJ 07974 DISQUALIFICATION 9/19/2018 PERMANENT BEECHER, GEORGE MD 9/26/1940 1073574059 137 EVERGREEN AVENUE NW PROVIDENCE NJ 07974 SUSPENSION 6/8/2016 9/19/2018 BEHRMAN, EDWARD DO 10/9/1932 520 HAMBURG TURNPIKE WAYNE NJ 07470 DISQUALIFICATION 12/1/1998 BEIRNE, MARY F. MD 6/25/1949 1881782662 75 ABE VORHEES AVENUE MANASQUAN NJ 08736 DISQUALIFICATION 7/19/2001 5/16/2011 BEKIER, JACQUELYN CHHA 10/11/1993 518 LAKE TERRACE BRADLEY BEACH NJ 07720 DISQUALIFICATION 1/31/2017 BELIAEV, KIRA CHHA 12/12/1957 108 36TH STREET UNION CITY NJ 07087 DISQUALIFICATION 2/20/2017 BELKOFF, MEYER DO 9/9/1921 29 ELMORA AVENUE ELIZABETH NJ 07202 DEBARMENT 7/17/1998 DECEASED BELL, BEANA 1/30/1982 9926 HALDEMAN AVENUE PHILADELPHIA PA 19115 DISQUALIFICATION 11/20/2015 BELL, KIMBERLY F. RN 11/9/1961 2030 HIGHWAY 35 N. UNIT K ORTLEY BEACH NJ 08735 SUSPENSION 6/20/2001 2/7/2020

BELL, SHANNON PHARM 2/23/1979 6591 MILL ROAD EGG HARBOR NJ 08234 DISQUALIFICATION 5/23/2017 TECH TOWNSHIP BELLAMY, BERNICE 5/24/1957 1 CRISPIN ROAD LUMBERTON NJ 08060 DEBARMENT 10/20/2004 BELLAMY, HARVEY H&B 9/30/1962 CRAF PO BOX 7450 TRENTON NJ 08625 DISQUALIFICATION 10/20/2004 TRANS. BELLO, REY N. MD 11/18/1957 1780796409 444 60TH STREET WEST NEW YORK NJ 07093 SUSPENSION 1/31/2011 PERMANENT BELMAR HOMETOWN 911 MAIN STREET BELMAR NJ 07719 SUSPENSION 2/5/2003 PHARMACY BELONY, IVELYSE LPN 9/4/1989 131 PARK PLACE, APT. 1 IRVINGTON NJ 07111 DISQUALIFICATION 3/28/2017 BELTZER, BLAIR MD 5/5/1957 1073635421 2025 HAMBURG TURNPIKE WAYNE NJ 07470 DEBARMENT 12/16/2015 BENKO, ALICIA PHARM 12/27/1986 FCI DANBURY RT 37, #60674- DANBURY CT 06811 DISQUALIFICATION 9/18/2009 TECH 050 BENNETT, SHARON CHHA 9/27/1954 736 EDGEWOOD AVENUE TRENTON NJ 08618 DISQUALIFICATION 1/31/2017 BENNETT-WILLIAMSON, LPN 7/12/1951 75 WALT WHITMAN WAY TRENTON NJ 08690 DISQUALIFICATION 8/27/2001 KATHLEEN BENSEMKY, AMINA CHHA 5/29/1967 2828 KENNEDY BOULEVARD, JERSEY CITY NJ 07306 DISQUALIFICATION 4/26/2019 PERMANENT APT. 361 BENSIMHON, GEORGES MD 2/1/1947 1649234394 1488 SHELBURNE COURT ALLENTOWN PA 18104 DEBARMENT 12/16/2015 BENTLEY, CYNTHIA RN 10/7/1959 220 GILPIN ROAD WILLOW GROVE PA 19090 DISQUALIFICATION 6/15/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BENTON, DEBORAH AKA LPN 5/10/1958 9 RADFORD PLACE WILLINGBORO NJ 08046 DISQUALIFICATION 10/18/2001 11/5/2018 KING, DEBORAH BERGER, SHELDON H. MD 5/26/1929 1032 ROUTE 34 MATAWAN NJ 07747 DEBARMENT 9/30/2000 BERKELHAMMER, MD 12/18/1941 230 W. JERSEY STREET ELIZABETH NJ 07202 DISQUALIFICATION 8/30/1990 EDWARD BERKS PSYCHIATRY 1104949149 146 SOUTH 5TH STREET READING PA 19602 DISQUALIFICATION 11/20/2015 BERMAN, LARRY R. DDS 12/14/1953 1326191347 308 RARITAN AVENUE HIGHLAND PARK NJ 08904 DISQUALIFICATION 8/24/2010 BERMAN, LARRY R. DDS 12/14/1953 1326191347 308 RARITAN AVENUE HIGHLAND PARK NJ 08904 DISQUALIFICATION 12/20/2012 BERRY, BRADLEY D. MD 4/10/1919 PO BOX 2008 GRUNDY VA 24614 DISQUALIFICATION 6/13/1991 DECEASED BEST, ALEXANDER C. 3/19/1969 PO BOX 7000 FORT DIX NJ 08640 SUSPENSION 7/20/2005 BEST, BREKKE AKA RN 6/10/1981 35 WOODROW AVENUE FRANKLIN LAKES NH 03235 DISQUALIFICATION 2/20/2018 SPADARO, BREKKE BETHEA, ALFREDA LPN 5/12/1951 1234 PROSPECT STREET TRENTON NJ 08638 SUSPENSION 10/20/2002 BEUKAS, STEPHEN DMD 9/3/1965 1275677213 27 ROUTE 34 NORTH COLTS NECK NJ 07722 DEBARMENT 3/30/2014 BEUKAS, STEPHEN DMD 9/3/1965 1275677213 MONMOUTH COUNTY FREEHOLD NJ 07728 DISQUALIFICATION 10/18/2018 CORRECTIONAL INSTITUTE, 1 WATERWORKS ROAD BEYNON-SERFASS, RN 12/11/1963 18 WILSON AVENUE CLARKS SUMMIT PA 18411 DISQUALIFICATION 11/30/2017 LEONOR BEZOZA, HOWARD M. MD 9/3/1952 PO BOX 372 SADDLE RIVER NJ 07458 SUSPENSION 7/20/2003 BHATTI, HAMID 10/3/1977 80 MILTON AVENUE, #1522 RAHWAY NJ 07065 DISQUALIFICATION 9/20/2012 9/10/2019 BIENSTOCK, DOUGLAS DO 6/27/1966 1831151356 245 DIAMOND BRIDGE HAWTHORNE NJ 07506 DEBARMENT 12/16/2015 AVENUE BIENSTOCK, DOUGLAS DO 6/27/1966 1831151356 245 DIAMOND BRIDGE HAWTHORNE NJ 07506 DISQUALIFICATION 5/12/2016 AVENUE BILENKIN, ELANA 8/19/1969 242 COMUNITY CIRCLE OLD BRIDGE NJ 08857 DISQUALIFICATION 4/15/1998 BINDER, RANDY RPH 2/19/1953 1972526572 FCI OTISVILLE, PO BOX 1000 OTISVILLE NY 10963 DISQUALIFICATION 8/20/2015 PERMANENT

BINDER, RANDY RPH 2/19/1953 1972526572 16 WINTER PLACE ABERDEEN NJ 07747 DISQUALIFICATION 9/20/2016 PERMANENT BIODIAGNOSTICS LAB 1407923568 181 NEW STREET PARSIPPANY NJ 07054 SUSPENSION 1/21/2015 SERVICES BIONDELLO JR., PHILIP 9/8/1966 41 CONCORD LANE BASKING RIDGE NJ 07920 DISQUALIFICATION 7/20/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BIO-SCIENCE LAB, INC. 1000 WOODBRIDGE COURT WOODBRIDGE NJ 07095 DEBARMENT 3/20/2000

BISHARA, GIRGIS MD 12/23/1921 859 BRIGHTON PLACE OCEAN CITY NJ 08226 DISQUALIFICATION 1/17/1987 DECEASED BITTNER, MELISSA C. RN 10/21/1976 436 RIVER DRIVE WESTVILLE NJ 08093 SUSPENSION 1/19/2005 BLACKMAN, NOEL MD 12/18/1947 1720209521 MOSHANNON VALLEY CI, 555 PHILLIPSBURG PA 16866 DISQUALIFICATION 11/30/2017 PERMANENT GEO DRIVE BLACKMAN, NOEL MD 12/18/1947 1720209521 MOSHANNON VALLEY CI, 555 PHILLIPSBURG PA 16866 DISQUALIFICATION 3/26/2017 PERMANENT GEO DRIVE BLANCO, ALEX DPM 2/21/1972 1881677987 180 LAFAYETTE AVENUE, PASSAIC NJ 07055 DISQUALIFICATION 8/24/2017 APT. 12A BLANCO, LAZARO PHARM 12/26/1990 401 46TH STREET, APT. 5 UNION CITY NJ 07087 DISQUALIFICATION 8/28/2017 TECH BLANTON, MALEEK CHHA 8/13/1992 640 LINE STREET CAMDEN NJ 08103 DISQUALIFICATION 7/14/2017 BLAU, SEYMOUR H. DPM 5/28/1923 36 COLLEGE DRIVE JERSEY CITY NJ 07305 SUSPENSION 11/20/2003 BLEIMAN, MICHAEL MD 8/24/1961 1821086463 1100 ROUTE 72 WEST, SUITE MANAHAWKIN NJ 08050 SUSPENSION 1/27/2017 4/27/2017 304 BLOOMFIELD PHARMACY 154 BLOOMFIELD AVENUE NEWARK NJ 07104 DISQUALIFICATION 1/31/2000

BLOT, EDWARD MD 3/25/1941 274 NORTH CENTER STREET ORANGE NJ 07050 DEBARMENT 7/5/2000

BLUM, NOEL 74 TWIN RIVERS DRIVE EAST WINDSOR NJ 08561 DISQUALIFICATION 6/1/1993 BLY, RODNEY 5/28/1965 4737 FRANKFORD AVENUE, PHILADELPHIA PA 19124 DISQUALIFICATION 11/20/2015 3RD FL BLYN, CHARLOTTE MD 11/18/1928 1669700910 511 WINDING WAY MERION STATION PA 19066 DISQUALIFICATION 11/20/2015 BMA MEDICAL 59-07 71ST AVENUE RIDGEWOOD NY 11385 SUSPENSION 10/20/2003 LABORATORY BOADU, JACOB RPH 9/23/1959 EUCLID TERRACE PARSIPPANY NJ 07054 SUSPENSION 8/20/2007 BOAMAH, KWAKU MD 2/4/1957 1154413029 101 HAVEN WAY MORGANVILLE NJ 07751 DEBARMENT 6/7/2017 8/2/2019 BOBADILLA, MARIA CHHA 6/2/1969 85 PRESIDENTIAL PATERSON NJ 07522 DISQUALIFICATION 3/5/2018 BOULEVARD, APT. 2K BOBRYSHEVA, SVETLANA CHHA 3/8/1961 29 FOREST GARDENS DRIVE MATAWAN NJ 07747 DISQUALIFICATION 9/26/2017

BODINE, DENISE RN 7/5/1964 66 YORK STREET, APT. 12 LAMBERTVILLE NJ 08530 DISQUALIFICATION 5/25/2011

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BOEHM, GREGORY MD 6/4/1949 1972678894 26777 LORAIN AVENUE, NORTH OLMSTEAD OH 44070 DISQUALIFICATION 11/20/2015 SUITE 716 BOGUSLAVSKIY, VADIM A & S IC 6/10/1948 1903 MADALINE DRIVE AVENEL NJ 07001 SUSPENSION 12/20/2001 BOGUSLAVSKIY, VADIM A & S IC 6/10/1948 1903 MADALINE DRIVE AVENEL NJ 07001 DISQUALIFICATION 3/25/2002 BOHUSLAWSKY, NINA RN 10/9/1970 PO BOX 4004 CLINTON NJ 08809 DISQUALIFICATION 2/20/2010 BOISVERT, RAYMOND RN 12/8/1961 2701 NW 23 BOULEVARD, GAINESVILLE FL 32605 DISQUALIFICATION 8/20/2015 JOHN APT. 225 BOND, CLIFTON MD 9/5/1956 418 JAMESTOWN COURT MOUNT LAUREL NJ 08054 DISQUALIFICATION 2/21/1992 BONDAR, SOFIYA DDS 8/24/1954 1952355158 2815 COYLE STREET, APT. BROOKLYN NY 11235 DISQUALIFICATION 11/18/2011 210 BONETT, OLGA 3/7/1967 5105 N. PARK DRIVE PENNSAUKEN NJ 08109 SUSPENSION 4/29/2003 BONILLA, CLEMY CHHA 4/17/1994 2809 YORKSHIP ROAD CAMDEN NJ 08104 DISQUALIFICATION 2/8/2017 BONNELL, STEPHANIE RN 12/18/1974 165 DEY GROVE ROAD MONROE NJ 08831 SUSPENSION 2/20/2002 BONSU, ACHIAA CHHA 1/20/1982 1414 BIRCHWOOD COURT NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 7/14/2017 3/3/2020 BONSU, KWADWO CHHA 8/5/1988 911 AZALEA DRIVE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 1/31/2017 BONSU, NANA CHHA 3/4/1985 68 MYRTLE AVENUE IRVINGTON NJ 07111 DEBARMENT 3/6/2018 BOODRAM, VERONA 10/31/1977 134 EVERGREEN PLACE 8TH EAST ORANGE NJ 07018 SUSPENSION 3/22/2006

BOONE, LESLIE RN 10/18/1961 122 SUMMIT AVENUE TRENTON NJ 08628 SUSPENSION 6/20/2002 BORCHARDT, KAREN RN 1/18/1952 4145 MILL CREEK DRIVE NORTH CHARLESTON SC 29420 SUSPENSION 6/17/2004

BORGES, JOHN MANUEL 4/16/1964 550 BUCKINGHAM DRIVE PISCATAWAY NJ 08854 DISQUALIFICATION 8/20/2010 BORNHOLDT, HAE SUK THERAPI 5/17/1958 PO BOX 1288 MCAFEE NJ 07428 SUSPENSION 9/19/2002 ST BORNSTEIN, KATHLEEN LPN 12/29/1963 136 73RD STREET NORTH BERGEN NJ 07047 SUSPENSION 2/19/2004 BOROWEC, LAWRENCE MD 7/22/1952 202 STATESBURY AVENUE NEWFIELD NJ 08344 DISQUALIFICATION 12/1/1998 BOROWEC, LAWRENCE MD 7/22/1952 202 STATESBURY AVENUE NEWFIELD NJ 08344 SUSPENSION 11/18/1997 BORRELLI, HENRY DPM 5/22/1958 1902839830 49 PROSPECT STREET LITTLE FALLS NJ 07424 DEBARMENT 4/6/2010 10/27/2017 BORTZ, AMANDA PHARM 1/25/1985 13 SWEET BRIAR DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 11/21/2016 4/5/2018 TECH BOSTICK, MICHELLE CHHA 6/16/1962 87 TILLINGHAST STREET NEWARK NJ 07108 DISQUALIFICATION 2/20/2017 BOTTENBLEY, CECIL J. DMD 6/6/1950 1245384304 16 FIRESIDE COURT WILLINGBORO NJ 08046 DISQUALIFICATION 4/9/1987

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BOUCHE, JASON 7/16/1984 6641 E. MEADOWLARK LANE PARADISE VALLEY AZ 85253 DISQUALIFICATION 5/20/2012

BOULOS-PLUDOWSKI, RPH 1/20/1958 493 RINGWOOD AVENUE PHILLIPSBURG NJ 08865 SUSPENSION 5/19/2005 3/11/2013 GEORGEANN BOWICK, JUDY C. CHHA 9/1/1951 1503 BOND STREET ASBURY PARK NJ 07712 SUSPENSION 8/20/2002 BOYD, DARRYL 1/27/1960 PO BOX 38, FCI FORT DIX NJ 08640 DISQUALIFICATION 7/18/2002 BOYKIN, ASHLEE CHHA 5/9/1984 602 HARBOR LANE SICKLERVILLE NJ 08081 DEBARMENT 3/6/2018 BOYKINS, TAMIKA CHHA 5/17/1989 235 ABLETT VILLAGE CAMDEN NJ 08105 DEBARMENT 5/16/2018 BRABHAM, THEODORE J. 9/10/1951 14 HAZARD STREET ELIZABETH NJ 07208 DISQUALIFICATION 12/20/2001 BRACEWORKS PROF 288 HIGHWAY 35 SOUTH EATONTOWN NJ 07724 SUSPENSION 8/20/2003 ORTHODONTIST BRACUTO, ANNMARIE RN 3/20/1962 1319 ST. GEORGE AVENUE RAHWAY NJ 07065 DISQUALIFICATION 9/12/2016 BRADLEY, EARL B. MD 5/10/1953 1669414553 1181 PADDOCK ROAD SMYRNA DE 19977 DISQUALIFICATION 10/20/2012 BRANCO, DOROTHY LPN 6/4/1969 1012 W. GENEVA STREET EGG HARBOR CITY NJ 08215 DISQUALIFICATION 5/11/2019 BRANDT, DOUGLAS A. 9/7/1959 5 HOWARD STREET VERONA NJ 07044 DISQUALIFICATION 2/20/2011 BRANDT, HERBERT L. RPH 10/15/1932 6 DEVONSHIRE DRIVE RANDOLPH NJ 07689 DISQUALIFICATION 2/20/2011 BRANDT, JEFFREY M. 5/13/1957 24 CRESTVIEW LANE MOUNT ARLINGTON NJ 07856 DISQUALIFICATION 11/17/2011 BRAUNSTEIN, MOSES 2404 BRONX PARKWAY BRONX NY 10458 DISQUALIFICATION 6/1/1993 BRAVER, ALEXANDER MD 10/18/1950 1811098650 127 CROAK AVENUE STATEN ISLAND NY 10314 DISQUALIFICATION 7/20/2007 BREEN, NICHOLAS DMD 10/2/1961 1730307836 7731 RUDDEROW AVENUE PENNSAUKEN NJ 08109 DISQUALIFICATION 8/18/1995 9/27/2013 BREEN, NICHOLAS DMD 10/2/1961 1730307836 7731 RUDDEROW AVENUE PENNSAUKEN NJ 08109 DISQUALIFICATION 5/14/1996 9/27/2013 BREIHOF, PETER 8/9/1970 51 COEYMAN AVENUE NUTLEY NJ 07110 DISQUALIFICATION 2/5/2019 BRESSMAN, DANIELLE RN 1/16/1981 40 HARBORAGE AVENUE BAYVILLE NJ 08721 DISQUALIFICATION 1/29/2019 BRETTLER, NORMAN AKA 2/3/1948 401 COUNTRY CLUB DRIVE CHERRY HILL NJ 08003 DISQUALIFICATION 5/12/2016 BRETTLER, NORBERT

BREWINGTON, CYNTHIA CHHA 7/3/1962 379 MILLRIDGE ROAD CLEMENTON NJ 08021 DISQUALIFICATION 1/31/2017 BRICK, ROGER MD 12/20/1949 31-33 WEST 11TH STREET NEW YORK NY 10026 SUSPENSION 12/15/2006 BRIGHAM, STEVEN C. MD 8/29/1956 1306012539 1094 CORBRIDGE COURT VOORHEES NJ 08043 DISQUALIFICATION 6/20/2018 BRINT, SAMUEL DO 1/6/1918 515 BIRD WAY CAMDEN NJ 08103 DISQUALIFICATION 12/15/1987 BRISTOL, KENNETH RN 1/2/1951 PO BOX 931 FLAGSTAFF AZ 06002 SUSPENSION 10/19/2006 BRITT, JANICE RN 2/4/1965 28 SCHOOL STREET SWANSEA MA 02777 DISQUALIFICATION 4/27/2019 BRIZER, DAVID ALLEN MD 1/22/1953 1518181270 255 W 85TH STREET, APT. 5B NEW YORK NY 10024 DISQUALIFICATION 6/30/2014

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BRIZER, DAVID ALLEN MD 1/22/1953 1518181270 6766 108TH STREET, APT. FOREST HILLS NY 11375 DISQUALIFICATION 2/20/2015 A62 BROADNAX, DEITRICH 7/12/1965 347 BELLEVILLE AVENUE, #B8 BLOOMFIELD NJ 07003 DISQUALIFICATION 11/25/1998

BROADWAY MEDICAL 227 BROADWAY PATERSON NJ 07501 DISQUALIFICATION GROUP BRODSKY, KONSTANTIN CHHA 1/1/1947 55 WEST 45TH STREET, FL 7R NEW YORK NY 10036 DEBARMENT 5/2/2017

BROOKHIM, ROBEN DDS 8/24/1958 444 MORRIS AVENUE ELIZABETH NJ 07208 SUSPENSION 8/20/2000 BROOKHIM, ROBEN DDS 8/24/1958 120 LAWRENCE DRIVE SHORT HILLS NJ 07078 DISQUALIFICATION 5/20/2015 BROOKMAN, HARVEY W. MD 3/20/1941 301 OXFORD VALLEY ROAD YARDLEY PA 19067 DISQUALIFICATION 4/13/1995

BROOKS JR., OSCAR COUNSE 11/8/1963 27 E VILLAGE OF STONEY MAPLE SHADE NJ 08052 DISQUALIFICATION 4/17/1995 LOR ROAD BROOKS, MAUREEN R. LPN 7/9/1954 110 THIRD AVENUE BELMAR NJ 07719 SUSPENSION 10/9/2003 BROWN, ALEXANDRIA N. RN 12/15/1965 803 DAWN LANE WILLIAMSTOWN NJ 08094 SUSPENSION 5/19/2005 BROWN, DANNY CHHA/C 8/15/1961 527 CENTRE STREET EASTON PA 18042 DISQUALIFICATION 8/6/2018 PERMANENT BROWN, DEANNA CHHA 12/17/1988 611 B. BINGHAM STREET NEPTUNE NJ 07753 DISQUALIFICATION 1/23/2018 BROWN, DERVENT CHHA 9/20/1959 151 FIRST STREET ENGLEWOOD NJ 07631 DEBARMENT 1/26/2018 BROWN, IMAN CHHA 10/20/1983 717 N. MICHIGAN AVENUE ATLANTIC CITY NJ 08401 DEBARMENT 7/14/2017 BROWN, KAYDIA CHHA 8/24/1985 1033 SEWALL AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 1/31/2017 BROWN, LAFONDA CHHA 5/20/1976 485 EAST 19TH STREET, APT. PATERSON NJ 07524 DEBARMENT 10/26/2017 #4-F BROWN, ROGER H. DMD 5/12/1955 1457460305 601 ROUTE 206, UNIT 30 BELLE MEAD NJ 08844 DEBARMENT 5/27/2005 BROWN. SAO LPN 10/30/1964 9 ALAN STREET WEST ORANGE NJ 07052 DEBARMENT 6/5/2017 BROWN-COLEY, KELLI LPN 7/10/1967 88 WEST 6TH STREET BAYONNE NJ 07002 DISQUALIFICATION 10/11/2017 BRUNELLE, ELIZABETH LPN 10/13/1950 5902 EAST 2ND STREET TUCSON AZ 85711 SUSPENSION 10/19/2006 BRYANT-DERRICK, LPN 10/18/1967 107 DEAL AVENUE NEPTUNE NJ 07753 DISQUALIFICATION 9/12/2016 BUCKLEY, MARIANNE LPN 1/3/1926 83 IRVING COURT TRENTON NJ 08610 SUSPENSION 5/20/2001 BUITRAGO, CARMEN LPN 8/2/1975 412 CLIFF STREET, APT. 1 FAIRVIEW NJ 07022 DISQUALIFICATION 7/12/2018 BULGER, PATRICE RN 2/16/1963 117 MILL CREEK ROAD BAYVILLE NJ 08721 DISQUALIFICATION 7/15/2002 BULLARD, ANGELA CHHA 2/5/1989 268 E. 21ST STREET, 3RD FL. PATERSON NJ 07513 DISQUALIFICATION 12/26/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE BUNCH, LATITIA LPN 9/9/1971 212 S. 27TH STREET CAMDEN NJ 08105 SUSPENSION 2/20/2002 BUNN, YAHMINAH CHHA 9/26/1983 22 GATLING COURT NEW BRUNSWICK NJ 08901 DISQUALIFICATION 5/2/2017 BUONO, DONNA RN 10/17/1964 61 S. LOCUST AVENUE MARLTON NJ 08053 SUSPENSION 9/19/2003 BURDETTE, KAYLA F. CHHA 10/26/1990 31 ISLAND AVENUE SEASIDE PARK NJ 08752 DISQUALIFICATION 11/14/2014 BURGOS, LEALYNN CHHA 1/31/1994 636 BILLINGS AVENUE PAULSBORO NJ 08066 DISQUALIFICATION 1/31/2017 BURKARD, JUDITH LPN 5/2/1956 320 7TH AVENUE, APT. 16 ASBURY PARK NJ 07712 DISQUALIFICATION 11/23/2009 11/23/2010 BURKE, WILLIAM MD 8/3/1937 PO BOX 670 NEW VERNON NJ 07976 SUSPENSION 11/20/2006 BURKES, JEFFREY DDS 7/21/1948 1073690137 176 LAKEWOOD AVENUE HO-HO-KUS NJ 07423 DISQUALIFICATION 2/19/2009 BURKETT, EILEEN PHARM 11/30/1952 1407 VIRGINIA COURT MARLTON NJ 08053 SUSPENSION 4/20/2011 TECH BURNETT, RASHEEDAH CHHA 1/26/1983 860 SOUTH 11TH STREET, NEWARK NJ 07108 DISQUALIFICATION 1/31/2017 APT. 4-B BURNS, MARGARET 12/9/1952 2429 WESTFIELD AVENUE SCOTCH PLAINS NJ 07076 SUSPENSION 9/19/2003 BURRELL, TIARA CHHA 3/26/1993 141 STRANGER AVENUE GLASSBORO NJ 08028 DISQUALIFICATION 7/19/2019 BURWELL-ADENIJI, LORIN CHHA 12/19/1987 1004 HIGH STREET BURLINGTON NJ 08016 DISQUALIFICATION 2/20/2017

BUSSEY, PAUL MD 10/22/1969 1356341424 1 MILL STREET WOODSTOWN NJ 08098 DEBARMENT 10/13/2015 BUSSEY, PAUL MD 10/22/1969 1356341424 187 KIRSCHLING DRIVE SWEDESBORO NJ 08095 DEBARMENT 1/22/2016 BUTT, ATIQ 2/2/1959 2524 FORD ROAD BRISTOL PA 19007 DISQUALIFICATION 6/15/2001 BUTTERHOF, TRACY RN 8/13/1960 501 S. BERLIN AVENUE EGG HARBOR CITY NJ 08215 SUSPENSION 4/20/2003 BUTTS, YOLANDA CNA 4/6/1988 600 PACIFIC AVENUE, APT. ATLANTIC CITY NJ 08401 DISQUALIFICATION 3/2/2020 102 BYADGI, CHETHAN MD 8/8/1963 1063537215 LACKAWANNA COUNTY SCRANTON PA 18509 DISQUALIFICATION 7/20/2017 PRISON, 1371 NORTH WASHINGTON AVENUE BYAHATI, PRAMILA MD 4/15/1944 1841212800 200 EXCHANGE STREET, UNIT PROVIDENCE RI 02903 DISQUALIFICATION 7/23/2020 317 BYERS, FAYE AKA BYERS, R & B 2/6/1943 44 PALM STREET, FL. 2 NEWARK NJ 07106 DEBARMENT 10/14/2005 RAYMOND TRANS CABALEIRO, YODALIO MD 12/3/1930 3700 KENNEDY BOULEVARD UNION CITY NJ 07087 DISQUALIFICATION 4/18/1986

CABALERIO, THERESA 4611 BERGENLINE AVENUE UNION CITY NJ 07087 DISQUALIFICATION 6/1/1993 CABAN, DESTINY CHHA 9/18/1996 105 BOYD STREET CAMDEN NJ 08105 DISQUALIFICATION 2/8/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CABATIC, VIRGINIA C. RN 6/11/1940 14 SPARROW ROAD RANDOLPH NJ 07869 SUSPENSION 5/19/2005 CABRERA, RAMON 6/29/1959 486 ZAMBORY STREET PERTH AMBOY NJ 08861 DEBARMENT 9/19/2011 BRETON CACERES, MARIO 8/26/1958 328 MARKET STREET CAMDEN NJ 08102 SUSPENSION 10/20/1998 CACERES, MARIO 8/26/1958 328 MARKET STREET CAMDEN NJ 08102 SUSPENSION 10/5/2000 CACI, FRANCIS R. DDS 2/18/1940 248 SOUTH SUMMIT AVENUE HACKENSACK NJ 07601 DISQUALIFICATION 12/8/1997 DECEASED

CACOILO, MARIA 10/31/1967 1150 AMBOY AVENUE EDISON NJ 08837 DISQUALIFICATION 4/29/2003 CAI, PING DMD 11/15/1962 1275667362 22 SAGE STREET HOLMDEL NJ 07733 DISQUALIFICATION 9/10/2012 9/15/2017 CALABRESE, ANGELO MD 6/12/1957 1891722237 FCI SCHUYKILL, PO BOX 759 MINERSVILLE PA 17954 DISQUALIFICATION 1/22/2016

CALABRESE, ANTHONY RN 12/28/1983 105 JOAN COURT JACKSON NJ 08527 DISQUALIFICATION 1/22/2020 CALDERON, TANISHA CHHA 11/26/1977 108 N. 16TH EAST ORANGE NJ 07019 SUSPENSION 3/20/2002 CALLAHAN, VICTORIA PHARM 5/23/1979 130 FROST AVENUE PHILLIPSBURG NJ 08865 DISQUALIFICATION 7/21/2017 PERMANENT TECH CALVELO, ARSENIO C. RN 3/15/1953 13515 SCENIC GLADE DRIVE HOUSTON TX 77059 SUSPENSION 6/19/2003 CAMACHO, OLGA CHHA 8/13/1969 176 KNAPP AVENUE CLIFTON NJ 07011 DISQUALIFICATION 1/17/2018 CAMP, SUZANNE RN 5/18/1954 PO BOX 423 PORT ELIZABETH NJ 08348 SUSPENSION 10/21/2010 CAMPANELLA-KAPLAN, LPN 2/12/1970 1355 W. POINT AVENUE MAYS LANDING NJ 08330 DISQUALIFICATION 4/10/2018 DONNA CAMPBELL JR., HIGHLAND MD 11/26/1966 1043270143 1009 MEADOWVIEW LANE MONT CLARE PA 19453 DISQUALIFICATION 11/20/2015 12/18/2020

CAMPIONE JR., FRANK PA 3/10/1970 1598856924 431 STONEY POINT ROAD BRICK NJ 08733 DISQUALIFICATION 9/16/2016 2/19/2020 CANALES JR., DELOVI 10/3/1966 11 ALBERT STREET TOMS RIVER NJ 08953 DEBARMENT 4/30/2010 4/30/2013 CANARES, ALEXANDER RN 11/23/1977 60 BROOKSIDE AVENUE, APT. SOMERVILLE NJ 08876 DISQUALIFICATION 5/2/2018 2B CANE, LAMONT NURSES PO BOX 90431 CAMDEN NJ 08012 SUSPENSION 8/18/1997 AIDE CANNON, JEROME 1/20/1965 4221 NORTH 6TH STREET PHILADELPHIA PA 19140 DISQUALIFICATION 12/29/2015 CANTAVE, MARIE CHHA 7/20/1979 1217 OCEAN AVENUE, APT. C- BRADLEY BEACH NJ 07720 DISQUALIFICATION 4/18/2017 12 CANTERMEN, LYNN RN 11/3/1975 518 N. HILDEBRAND AVENUE GLENDORA NJ 08029 DISQUALIFICATION 5/2/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CAPACIO, RICHARD DC 10/3/1958 1245230929 99 ANNAPOLIS DRIVE SICKLERVILLE NJ 08081 SUSPENSION 12/20/2006 CAPILLI, MICHAEL A. DC 5/14/1960 427 HOYT STREET LONG BRANCH NJ 07740 SUSPENSION 8/9/2001 CAPITANO, PETER RPH 2/7/1955 FCI SCHUYLKILL, PO BOX 759 MINERSVILLE PA 17954 DISQUALIFICATION 11/20/2015

CAPO. LASARAH CHHA 9/22/1988 50-52 ROSA PARK PATERSON NJ 07501 DISQUALIFICATION 1/31/2017 BOULEVARD, APT. 5 CAPOBIANCO, LEO J. DO 3/19/1966 1063483097 7 CASTLE COURT RANDOLPH NJ 07860 DISQUALIFICATION 9/5/2002 6/8/2018 CAPPIELLO, RAFAEL MD 7/20/1930 2704 BRIENZA WAY LAS VEGAS NV 89117 DEBARMENT 8/19/1999 CAPRIOLA, EDWARD MD 7/20/1942 313 S. FRANK ROGERS HARRISON NJ 07029 SUSPENSION 12/20/2006 DECEASED CARABALLA, CARLA CHHA 1/25/1958 742 EAST SEVENTH STREET PLAINFIELD NJ 07062 DISQUALIFICATION 6/13/2017 PERMANENT CARAGINE JR., PAUL J. MD 5/1/1945 1 SAWMILL ROAD KINNELON NJ 07504 DISQUALIFICATION 7/18/2001 CARCHIA, ETTORE DC 8/21/1960 994 SANDY CIRCLE MANAHAWKIN NJ 08050 SUSPENSION 2/20/2006 CARDENAS, RN/LPN 11/21/1953 274 BATH AVENUE, #22 LONG BRANCH NJ 07740 SUSPENSION 5/20/2001 PRESENTACION E. CARDILLO, JOHN 7/18/1956 162 GARFIELD STREET BERKELEY HEIGHTS NJ 07922 SUSPENSION 9/4/2005 CARDILLO, JOHN 7/18/1956 162 GARFIELD STREET BERKELEY HEIGHTS NJ 07922 DEBARMENT 5/20/2006 CARDILLO, RICHARD C. MD 7/22/1955 1477520807 2893 BIRCH ROAD SUAMICO WI 54173 DEBARMENT 3/27/2002 CARDINAL, PETER MD 11/29/1958 1104985142 520 WALNUT STREET, APT. 3 LEMOYNE PA 17043 DISQUALIFICATION 11/20/2015

CARDOSO SR., LUCIO MD 6/23/1958 1639119019 253 LAFAYETTE STREET NEWARK NJ 07105 SUSPENSION 2/22/2012 CARDOSO SR., LUCIO MD 6/23/1958 1639119019 FCI FORT DIX, PO BOX 38 FORT DIX NJ 08640 DISQUALIFICATION 2/3/2014 CAREPOINT MEDICAL 1396744694 4860 COX ROAD, SUITE 300 GLEN ALLEN VA 23060 DISQUALIFICATION 11/20/2015 CAREY JR., CHARLES B. 2/1/1979 218 BRIANT PARK DRIVE SPRINGFIELD NJ 07081 DISQUALIFICATION 5/20/2015 CARIDAD, MICHELLE CHHA 1/22/1971 10 BROOKSIDE COURT TOMS RIVER NJ 08753 DISQUALIFICATION 2/8/2017 CARIDEO, IDA MD 2/18/1957 1578842977 7 MALKE DRIVE WAYSIDE NJ 07712 DISQUALIFICATION 6/7/1999 8/1/2012 CARINO, JOVY 12/15/1964 37 JAMES STREET BLOOMFIELD NJ 07003 SUSPENSION 5/29/2009 CARLSON, LILLIAN MAE RN 8/5/1956 275 HIGH STREET APT. Q334 GLASSBORO NJ 08028 DISQUALIFICATION 6/18/2009

CARLUCCI JR., WILLIAM A. RPH 9/7/1943 1902120363 FCI FORT DIX, PO BOX 38 FORT DIX NJ 08640 DEBARMENT 9/25/2014 CARLUCCI, ROBERT A. RPH 9/7/1943 1639493091 PO BOX 759 MINERSVILLE PA 17954 DEBARMENT 9/25/2014 CARMENATY, ANTHONY LPN 4/13/1991 28 SUMMER STREET, APT. PASSAIC NJ 07055 DISQUALIFICATION 5/25/2019 B11 CARMONA, ALICE Y. 12/9/1957 78 DAWN STREET VINELAND NJ 08302 DEBARMENT 10/23/2000 CARR, JOEL R. DO 1/1/1960 1275586489 8 JASMINE ROAD LUMBERTON NJ 08048 SUSPENSION 3/2/2011

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CARR, PATRICIA 8/1/1947 PO BOX 91 BROWNS MILLS NJ 08015 DISQUALIFICATION 7/19/2001 CARRION, NANCY CHHA 7/18/1979 76 ZABRISKIE STREET JERSEY CITY NJ 07307 DEBARMENT 3/5/2018 CARRION, SARAH CHHA 7/21/1971 1086 KENYON AVENUE PLAINFIELD NJ 07060 DEBARMENT 8/9/2018 CARROLL, KIMBERLY J. LPN 7/3/1964 18 LEE AVENUE HADDONFIELD NJ 08033 DISQUALIFICATION 8/18/2011 CARSON, YOLANDA CHHA 11/21/1968 65 DALES AVENUE, APT. 1137 JERSEY CITY NJ 07306 DISQUALIFICATION 1/31/2017

CARTER, DARRICKA C. DPM 1/1/1965 2505 ST. REGIS DRIVE RICHMOND VA 23236 DISQUALIFICATION 7/20/2010 CARUSO, EDMUND M. DMD 7/30/1958 1811132442 2275 KENNEDY BOULEVARD JERSEY CITY NJ 07304 DISQUALIFICATION 11/10/1994

CASAS, JOSE MD 12/23/1933 215 PASSAIC AVENUE PASSAIC NJ 07055 DEBARMENT 5/24/1999 CASAVINA, PHILIP 5/11/1929 244 KNOX AVENUE CLIFFSIDE PARK NJ 07650 DISQUALIFICATION CASCIO, DANIEL RN 3/5/1956 17 SEGUR STREET DOVER NJ 07801 SUSPENSION 5/20/2002 CASTANEDA, JOSE E. APN 11/3/1974 1699840264 1925 PACIFIC AVENUE ATLANTIC CITY NJ 08401 SUSPENSION 2/22/2012 CASTANEDA, JOSE E. APN 11/3/1974 1699840264 194 E. 7TH STREET CLIFTON NJ 07011 DISQUALIFICATION 1/26/2015 CASTANON, ROBERTO 5/1/1947 555 GEO DRIVE PHILLIPSBURG PA 16866 DISQUALIFICATION 9/16/2011 CASTELLANO, DOLORES PASSAIC 4/8/1949 4300 SW 57TH STREET MIAMI FL 33155 SUSPENSION 6/17/2004 FAMILY MEDICAL

CASTILLO, AL JEHDD CHHA 7/16/1986 170 32ND WEST BAYONNE NJ 07002 DISQUALIFICATION 6/28/2018 CASTILLO, HECTOR L. MD 4/18/1956 1528198124 1000 MADISON AVENUE PATERSON NJ 07501 DEBARMENT 2/19/2012 CASTILLO, STEVEN A. DDS 4/21/1962 1134342017 PO BOX 16421 JERSEY CITY NJ 07306 DISQUALIFICATION 5/5/1997 CATANIA, RAYMOND DO 11/15/1961 1023094711 5 BRIARWOOD DRIVE EAST WARREN NJ 07059 DISQUALIFICATION 4/16/2021 CATANZARO, DANIEL DC 10/19/1959 28 ETOWAH RIDGE DRIVE, CARTERSVILLE GA 30120 SUSPENSION 12/20/2005 SW CATANZARO, VINCENT F. MD 5/22/1947 560 MAIN STREET ALLENHURST NJ 07711 DISQUALIFICATION 6/1/1993 DECEASED CATHERS, THOMAS LPN 2/19/1972 707 BURLINGTON AVENUE DELANCO NJ 08075 DISQUALIFICATION 4/6/2019 CAVALLARO, KEVIN RN 3/27/1986 630 SALEM AVENUE FRANKLINVILLE NJ 08322 DISQUALIFICATION 5/11/2019 PERMANENT CAVALLI, DEAN 762 BROADWAY CAMDEN NJ 08103 DISQUALIFICATION CAVE, SANDY 3/10/1972 109 BOBWHITE ROAD ROYAL PALM BEACH FL 33411 DISQUALIFICATION 5/20/2012 CECE, ANGELO DMD 5/25/1957 1033396593 566 NYE AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 1/19/1996 CEDENO, HUMBERTO RPH 2/11/1925 601 ELIZABETH AVENUE ELIZABETH NJ 07206 DISQUALIFICATION 5/3/1984 CENTRAL DIAGNOSTICS 256 SMITH STREET PERTH AMBOY NJ 08861 DISQUALIFICATION 5/8/1989 LAB

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CENTRAL JERSEY MENTAL 525 PARK AVENUE PLAINFIELD NJ 07067 DISQUALIFICATION CENTER CENTRELLI, MARC DC 8/1/1960 176 ALPINE TRAIL SPARTA NJ 07871 SUSPENSION 7/21/2008 CHA, DONG S. MD 5/1/1938 608 S. BROAD STREET WOODBURY NJ 08096 DISQUALIFICATION 12/1/1998 CHACK, JOEL DO 3/11/1956 1093739096 5 GWEN COURT CHERRY HILL NJ 08003 DISQUALIFICATION 8/13/2011 1/6/2012 CHACKER, JASON PA 1/13/1983 1609058916 1030 DOMINO LANE WARMINSTER PA 18974 DISQUALIFICATION 7/10/2020 CHAI, CHRISTINA RPH 8/20/1984 1689997835 2461 LEIGHTON STREET FORT LEE NJ 07024 DISQUALIFICATION 3/24/2016 CHAIKEN, BARBARA LCSW 4/8/1952 1871768465 419 OTISCO DRIVE WESTFIELD NJ 07090 DISQUALIFICATION 6/1/1993 CHAM, WILLIAM C. MD 8/15/1938 11 HICKORY DRIVE CHESTER TOWNSHIP NJ 07930 SUSPENSION 8/29/1997 CHAMBERS, CAROL CHHA 9/25/1956 1022 STUYVESANT AVENUE IRVINGTON NJ 07111 SUSPENSION 1/20/2004 CHAMPION, MARY RN/CHH 9/26/1963 91 MOUNT AIRY AVENUE, EGG HARBOR NJ 08234 SUSPENSION 6/20/2005 6/11/2013 MARGARET A SOUTH CHANDLER, BRYAN K. 6/15/1967 10 ELLINGTON STREET, #1 EAST ORANGE NJ 07017 DISQUALIFICATION 8/28/2008 CHANDLER, CHARLES PA 10/11/1958 1417996901 219 N. WALNUT STREET, FL. 1 EAST ORANGE NJ 07017 DISQUALIFICATION 11/4/2009

CHANSKY, CHRISTINE MD 8/19/1968 1508125600 820 NORTH AVENUE WESTFIELD NJ 07090 DISQUALIFICATION 3/20/2018 CHAPLAN, ABRAHAM MD 11/17/1929 384 NORTH WOODLAND ENGLEWOOD NJ 07631 DISQUALIFICATION 6/1/1993 STREET CHARLES, ESTHER CHHA 7/22/1987 380 UNION AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 3/6/2018 CHATMON, ALTON RPH 4/10/1970 1790091742 RR8, BOX 370 BRIDGETON NJ 08302 DEBARMENT 3/3/2017 CHAUDHRY, YASMIN T. 1/18/1962 333 NORTH BROAD STREET ELIZABETH NJ 07028 SUSPENSION 7/21/1997 CHEESE, EPHONIA CHHA 11/15/1989 18 PATRIOT LANE WILLINGBORO NJ 08046 DISQUALIFICATION 5/16/2018 CHEN, BONNIE MD 1/14/1964 1750373486 243 HORSENECK ROAD FAIRFIELD NJ 07004 DISQUALIFICATION 8/12/2018 PERMANENT CHEN, KENNETH H. MD 5/23/1937 244 BROADWAY NEWARK NJ 07104 SUSPENSION 5/7/1999 CHEN, TAN MD 6/10/1945 12 LORRAINE DRIVE PINE BROOK NJ 07058 DISQUALIFICATION 11/5/1999 CHERVIN, ARON 7/18/1947 36 LAKE DRIVE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 2/11/2016 CHESTON, EBONY CHHA 11/17/1981 33 NEWELL AVENUE TRENTON NJ 08618 DISQUALIFICATION 3/6/2018 CHHADEH, AHED 3/25/1974 401 NEW BRUNSWICK AVE., EAST BRUNSWICK NJ 08816 DISQUALIFICATION 11/21/2016 APT 221 CHIAPPETTA, THERESA 7/6/1974 8 STEINHARDT AVENUE OLD BRIDGE NJ 08857 DEBARMENT 9/15/2008 CHIAPPETTA, THERESA 7/6/1974 8 STEINHARDT AVENUE OLD BRIDGE NJ 08857 DISQUALIFICATION 11/12/2009 CHICCO, LUKE #65503- 3/11/1973 FCI FAIRTON, PO BOX 420 FAIRTON NJ 08320 DISQUALIFICATION 2/5/2019 050

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CHIKOWSKI, JOHN RN 12/20/1980 121 WEST 29TH STREET, 2ND BAYONNE NJ 07002 DISQUALIFICATION 10/24/2018 4/9/2019 FL CHILDREN'S DENTAL 1992974406 3700 KENNEDY BOULEVARD UNION CITY NJ 07087 DEBARMENT 9/15/2017 CENTER CHILLEMI, SALVATORE 7/10/1962 29 BERKSHIRE DRIVE SEWELL NJ 08080 DISQUALIFICATION 6/10/2011 CHIRUMAMILLA, RPH 212 E. PITTSBURGH AVENUE WILDWOOD CREST NJ 08260 DISQUALIFICATION 3/11/1985 RAMABU CHIZHOV, ELLA 12/24/1946 200 WINSTON DRIVE #C1104 CLIFFSIDE PARK NJ 07010 SUSPENSION 7/21/2008

CHIZHOV, SERGEY 6/12/1946 200 WINSTON DRIVE CLIFFSIDE PARK NJ 07010 DISQUALIFICATION 9/20/2007 CHLOROS, STACY LPN 6/11/1974 323 GILL LANE ISELIN NJ 08830 SUSPENSION 5/18/2006 CHOI, JEHEE RN 11/27/1965 31 PINE RIDGE LANE MANSFIELD CENTER CT 06250 DISQUALIFICATION 3/27/2018 CHRISTENSEN, CYNTHIA RN 12/22/1962 20 SKYLINE DRIVE HAZLET NJ 07730 SUSPENSION 10/18/2001 CHRISTJOHN, COLLEEN M. LPN 10/27/1964 CORSON ROAD SOUTH SEAVILLE NJ 08246 DISQUALIFICATION 8/11/2007 CHRISTMAS, ARTHUR 6/7/1978 66 NORTH 11TH STREET NEWARK NJ 07107 DEBARMENT 6/16/2006 CHRISTPHONTE, CAIRY CHHA 5/27/1962 1976 OSTWOOD TERRACE UNION NJ 07083 DISQUALIFICATION 9/9/2019 PERMANENT CHU, ALICE MD 6/6/1957 1962513366 1512 PALISADE AVENUE, FORT LEE NJ 07024 DISQUALIFICATION 9/24/2019 APT. 6P CHUDRY, RAZA 4/6/1959 RD #5 FEDERAL PRISON LEWISBURG PA 17837 SUSPENSION 9/19/2002 CHUGH, JAGDISH MD 12/1/1953 1609980366 1 CORINE COURT LONG VALLEY NJ 07853 DISQUALIFICATION 12/2/2019 CHUKWUANI, ROSETTA CHHA 2/5/1962 3 LISZKA LANE SAYREVILLE NJ 08872 SUSPENSION 2/28/2009 CHULAK, GENADY 9/4/1955 242 COMMUNITY CIRCLE OLD BRIDGE NJ 08857 DISQUALIFICATION 4/15/1996 CHUNMUANG, PRASERT MD 5/15/1942 401 DEVONSHIRE PLACE FRANKLIN LAKES NJ 07417 DISQUALIFICATION 6/14/1993 CHUPREVICH, EILEEN D. RN 11/15/1948 8 STANTON PLACE BUTLER NJ 07405 SUSPENSION 1/20/2003 CIALLELLA, GINA AKA DC 4/14/1962 57 GREEN STREET WOODBRIDGE NJ 07095 DISQUALIFICATION 3/24/2000 GARCEN, GINA CICCONE, GREGORY 12/22/1976 5 WATERS EDGE DRIVE LITTLE EGG HARBOR NJ 08087 SUSPENSION 5/15/2005 CICERO, BARBARA RN 6/12/1937 91 LINCOLN AVENUE SOMERVILLE NJ 08876 SUSPENSION 8/20/2001 CICERO, RALPH DDS 5/8/1944 1740449305 245 BALDWIN STREET SUCCASUNNA NJ 07876 DEBARMENT 3/6/2014 CICERON, ANDRE MD 11/12/1944 1265526586 621 BANNING AVENUE NORTHFIELD NJ 08225 DISQUALIFICATION 2/8/2019 PERMANENT CITILAB CORPORATION 333 NORTH BROAD STREET ELIZABETH NJ 07028 SUSPENSION 12/1/1998 CLACKLEY, MACK O. LPN 3/9/1962 PO BOX 150 DELMONT NJ 08314 SUSPENSION 9/20/2001 CLAPPER, STEPHANIE LPN 11/19/1979 169 NAUTILUS MANAHAWKIN NJ 08050 DISQUALIFICATION 2/26/2010 CLARK, INDIA CHHA 8/24/1989 5 SECOND AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 7/14/2017 5/6/2021

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CLARK, JAMES 9/26/1955 380 MOUNTAIN ROAD #12 UNION CITY NJ 07087 SUSPENSION 9/27/2007 CLARK, JOVONNE CHHA 12/1/1983 1605 SEWALL AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 8/22/2017 CLARK, KEVIN 9/16/1956 537 TRINITY PLACE WESTFIELD NJ 07090 SUSPENSION 10/5/2009 CLARK, NORMAN L. MD 7/14/1952 5 TARA DRIVE PARSIPPANY NJ 07054 SUSPENSION 3/2/1999 CLARK, NYKEBA CHHA 4/7/1980 807 N. INDIANA AVENUE ATLANTIC CITY NJ 08401 DEBARMENT 1/24/2018 CLARK, RAYONNE 9/25/1979 844 CENTRE STREET TRENTON NJ 08611 SUSPENSION 7/20/2003 CLARK, RAYONNE 9/25/1979 844 CENTRE STREET TRENTON NJ 08611 DISQUALIFICATION 8/13/2003 CLARKE, KIRK CHHA 10/7/1967 218 YOUNGS ROAD TRENTON NJ 08619 DISQUALIFICATION 7/30/2019 PERMANENT CLARKE, MICHELLE CHHA 5/27/1971 75 NORTH WALNUT STREET, EAST ORANGE NJ 07017 DISQUALIFICATION 1/30/2017 PERMANENT APT. 6C CLAVIJO, LAURA RN 7/5/1981 908 CLARK CIRCLE FLEMINGTON NJ 08822 DISQUALIFICATION 8/28/2017 CLEMENTE, JOHN MD 4/11/1955 1982933271 20 PILGRIM WAY COLTS NECK NJ 07722 DEBARMENT 11/29/2015 CLEMENTE, JOHN MD 4/11/1955 1982933271 20 PILGRIM WAY COLTS NECK NJ 07722 DISQUALIFICATION 4/20/2015 CLEMMENTS, RALPH W. MD 11/16/1923 7304 CENROSE CIRCLE WESTWOOD NJ 07675 DEBARMENT 9/12/2008 CLIN-PATH LABORATORY, 626 N. 38TH STREET BELLEVILLE IL 62223 DISQUALIFICATION 6/4/1997 INC. COBB, ROY MD 3/3/1957 1548350556 504 SUMMIT AVENUE MAPLEWOOD NJ 07040 DISQUALIFICATION 6/5/2017 PERMANENT COBB, WILLIAM A. MD 10/20/1942 1679666903 2 WEST RIVER STYX ROAD HOPATCONG NJ 07843 DEBARMENT 3/16/2011 PERMANENT COCCO, KRISTEN RN 4/22/1975 44 SYRACUSE DRIVE CHERRY HILL NJ 08056 DISQUALIFICATION 6/5/2017 CODDINGTON, DE'LYNNE CHHA 12/15/1992 904 MAIN STREET BRADLEY BEACH NJ 07720 DISQUALIFICATION 11/8/2017

COHEN, BARRY E. 5/19/1953 6326 NW 80TH TERRACE POMPANO BEACH FL 33067 SUSPENSION 3/20/2006 COHEN, JUDAH L. MD 8/31/1953 1000 GALLOPING HILL ROAD UNION NJ 07083 DISQUALIFICATION 4/24/1998

COHEN, ROBERT G. RN/APN 11/16/1950 51 KRISTEN COURT MATAWAN NJ 07747 DISQUALIFICATION 3/24/2003 COHEN, WENDY E. MD 3/23/1944 1619024056 151 N. DEAN STREET ENGLEWOOD NJ 07631 SUSPENSION 5/10/2012 DECEASED COLADONATO, JOSEPH MD 5/28/1943 9760 EVERGREEN AVENUE SEAFORD DE 19973 DEBARMENT 2/3/2006 COLBERT, DONNA CHHA 2/24/1956 183 ROUTE 35 WALL TOWNSHIP NJ 07719 DISQUALIFICATION 7/14/2017 PERMANENT COLEMAN, BARBARA CHHA 3/8/1950 81 LINCOLN PARK, APT. 5B NEWARK NJ 07102 DISQUALIFICATION 1/31/2017 COLEMAN, BETH RN 11/14/1975 1598919466 12 NORTH ELMIRA STREET ATHENS PA 18810 DISQUALIFICATION 5/12/2016 COLETTI, ROGER MD 12/22/1945 1770508053 324 CAPTAINS CL. LEWES DE 19958 DISQUALIFICATION 1/5/2018 PERMANENT COLEY, CHERYL CHHA 3/16/1994 17 NORTH 3RD STREET PATERSON NJ 07522 DISQUALIFICATION 1/22/2018 COLLIER, BERT D. MD 12/6/1947 4933 N. WILDWOOD AVENUE MILWAUKEE WI 53217 DEBARMENT 5/29/2001 9/20/2013

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE COLLIER, KENYA CHHA 9/19/1980 708 THIRD AVENUE, APT. 13- ASBURY PARK NJ 07712 DISQUALIFICATION 1/31/2017 B COLLIER, KISHA CHHA 7/20/1990 54 FEDERAL COURT GALLOWAY NJ 08205 DISQUALIFICATION 5/2/2017 COLLINS, JEAN RN 6/10/1957 218 COPELAND AVENUE LYNDHURST NJ 07071 DISQUALIFICATION 4/24/2018 COLON, KAREN L. LPN 11/29/1973 1020 MCGUIRE DRIVE TOMS RIVER NJ 08753 SUSPENSION 6/20/2005 COLON-TORRES, FRANCIS CHHA 3/28/1973 437 STUYVESANT AVENUE IRVINGTON NJ 07111 SUSPENSION 11/7/2008 M. COMESANAS, MARIO MD 11/25/1955 1508922659 COLUMBIA TURNPIKE FLORHAM PARK NJ 07932 DISQUALIFICATION 8/10/2007 COMPAS, JEAN CLAUDE MD 11/6/1948 1720178148 255 EASTERN PARKWAY, BROOKLYN NY 11238 DISQUALIFICATION 7/20/2015 APT. D3 COMRIE, SHIRLEY M. CHHA 7/22/1957 7 DUFFELD DRIVE TRENTON NJ 08628 SUSPENSION 7/18/2002 CONARD, MICHELLE LPN 3/26/1955 16 ELDRIDGE AVENUE TRENTON NJ 08648 DISQUALIFICATION 7/20/2009 CONDON, MARJORIE MD 3/26/1960 329 FRANKLIN AVENUE RIDGEWOOD NJ 07450 DEBARMENT 11/2/2019 CONNERS, LAURA LPN 6/9/1976 11 FENWAY ROAD HAMILTON NJ 08620 SUSPENSION 3/20/2002 CONOVER, WILLIAM S. LPN 7/23/1965 225 RUTLAND AVENUE MOUNT HOLLY NJ 08060 SUSPENSION 5/20/2004 CONTE, SALVATORE MD 9/25/1964 1174688493 NEW YORK RRM, PO BOX BROOKLYN NY 11232 DISQUALIFICATION 10/3/2019 329014 CONTEH, AMARA S. MD 8/10/1943 3 OLD TAPPAN ROAD OLD TAPPAN NJ 07675 SUSPENSION 9/20/2007 CONTI, VINCENT MFT 1/20/1935 1023189644 180 PROSPECT AVENUE MORRIS PLAINS NJ 07950 DISQUALIFICATION 9/23/2016 COOPER STREET 301 COOPER STREET CAMDEN NJ 08012 DISQUALIFICATION 5/2/1990 PSYCHIATRIC GROUP COPLIN, GEORGE J. MD 1/23/1908 528 EAST JERSEY STREET ELIZABETH NJ 07206 DISQUALIFICATION 6/1/1993 DECEASED COPPOLA, KELLY AKA PHARM 3/21/1985 52 CORNELL DRIVE HAZLET NJ 07730 DISQUALIFICATION 9/23/2016 FURLONG, KELLY TECH CORNELY, MICHAEL P. DC 12/11/1962 1326199803 6650 BROWINING ROAD MERCHANTVILLE NJ 08109 DISQUALIFICATION 12/1/1998 CORREA-HUNTER, LOUISA DDS 6/17/1965 372 FOREST AVENUE PARAMUS NJ 07652 SUSPENSION 10/22/2010 CORSON, KENNETH E. MD 5/12/1904 5 SOUTH MYRTLE STREET VINELAND NJ 08360 DISQUALIFICATION DECEASED CORTEZ, JESSICA CHHA 4/21/1983 114 EDWARDS AVENUE LANDISVILLE NJ 08326 DISQUALIFICATION 9/6/2017 COSTA, LAWRENCE J. 4/25/1948 441 PENN AVENUE FORKED RIVER NJ 08731 DISQUALIFICATION COSTIGAN, KEVIN LCSW 8/26/1955 132 FRANKLIN AVENUE, APT. LONG BRANCH NJ 07740 SUSPENSION 3/21/2000 2 COSTINO JR., JOHN DO 7/22/1944 1811978414 404 SURF AVENUE WILDWOOD NJ 08260 DISQUALIFICATION 8/18/2011

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE COTTRELL, LISA L. CHHA 8/12/1963 290 ROUTE 9 NORTH, APT C5 WARETOWN NJ 08758 DISQUALIFICATION 9/30/2010

COUCH FISHER, SUSAN CHHA 10/5/1955 10 PLACID LANE WILLINGBORO NJ 08046 DISQUALIFICATION 2/8/2017 COUGHLIN, CATHERINE K. RN 8/29/1956 PO BOX 22 LIMESTONE PA 16234 DISQUALIFICATION 9/18/2009 COULTON, DIANE LPN 8/7/1961 272 BIRCH DRIVE LEVITTOWN PA 19054 DISQUALIFICATION 9/13/2018 COVERDALE, JULIE ANN RN 8/3/1962 909 CINNAMINSON AVENUE PALMYRA NJ 08065 SUSPENSION 4/20/2003

COVILLE, FREDERICK A. MD 9/29/1957 1679728307 230 N. MAPLE AVENUE MARLTON NJ 08050 DEBARMENT 4/17/1997 8/16/2012 COVILLE, FREDERICK A. MD 9/29/1957 1679728307 51-37 HAVENUEN AVENUE OCEAN CITY NJ 08226 DISQUALIFICATION 10/26/1998 8/16/2012 COVONE, DOMINICK 7/14/1949 FCI FORT DIX, BOX 38 FORT DIX NJ 08640 DISQUALIFICATION 10/18/2001 COWAN JR., JAMES MD 3/19/1944 1063527026 572 WEST SADDLE RIVER RIDGEWOOD NJ 07450 DISQUALIFICATION 9/20/2016 PERMANENT ROAD COWAN JR., JAMES MD 3/19/1944 1063527026 28 W. 3RD STREET, APT. 1347 SOUTH ORANGE NJ 07079 DISQUALIFICATION 12/6/2017 PERMANENT

COWAN, MARYANNE LCSW 4/20/1954 572 WEST SADDLE RIVER RIDGEWOOD NJ 07450 DISQUALIFICATION 12/21/2016 DECEASED ROAD COWINS, KIMBLIN CHHA 3/20/1960 75 SHADY LANE HAMBURG NJ 07419 DISQUALIFICATION 9/20/2019 PERMANENT COWINS, KIMBLIN LPN 3/20/1960 75 SHADY LANE HAMBURG NJ 07419 DISQUALIFICATION 9/20/2019 CRAPANZANO SR., PETER DDS 1/16/1950 1861566960 46 VILLAGE COURT HAZLET NJ 07730 SUSPENSION 4/26/2011

CRAWFORD, KENNETH CNA 10/13/1962 B-8 ABBINGTON DRIVE PHILLIPSBURG NJ 08865 DISQUALIFICATION 4/6/2006 CRAWFORD, KENNETH CNA 10/13/1962 199A FIDDLER ELBOW ROAD PHILLIPSBURG NJ 08865 SUSPENSION 8/20/2006

CRAY, JASON E. COTTAG 7/8/1969 WARREN COUNTY JAIL BELVIDERE NJ 07823 DISQUALIFICATION 8/21/2000 E AIDE CRESTA, NICOLE AKA RN 2/11/1983 2009 KICKAPOO TERRACE VINELAND NJ 08361 DISQUALIFICATION 3/28/2017 RIVERA, NICOLE CRISCITO, MARIO MD 5/22/1939 1063411957 32 CHELSEA DRIVE LIVINGSTON NJ 07039 DISQUALIFICATION 7/1/2017 PERMANENT CRISSIEN, CINDY 3/4/1982 78 FORNELIOUS AVENUE CLIFTON NJ 07013 SUSPENSION 1/18/2007 CRITCHFIELD, CYNTHIA RPH 6/12/1966 PIN OAK COURT SHAMONG NJ 08088 SUSPENSION 4/20/2008 6/15/2017 AKA SULLIVAN, CYNTHIA CROCKER JR., KENNETH 12/11/1975 15 VIOLA AVENUE LEONARDO NJ 07737 DEBARMENT 7/17/2009 7/17/2014 CROMARTIE, CHERISE CHHA 10/12/1976 25 RONALD ROAD LAKEWOOD NJ 08701 DEBARMENT 7/19/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE CRON, EVA RN 5/18/1944 31 CHERRY STREET WARWICK NY 10990 SUSPENSION 9/27/2007 CROUSE, FARRELL R. MD 9/20/1932 1386795292 101 NORTH MAIN STREET WOODSTOWN NJ 08098 DEBARMENT 3/18/2015 CROWDER, CLAXTON L. MD 7/1/1942 115 ASHBY COURT MOUNT LAUREL NJ 08054 DISQUALIFICATION 1/13/2006 CROWLEY, TERRI RN 7/27/1959 5 THOREAU ROAD HAMILTON SQUARE NJ 08690 DEBARMENT 11/13/2017 CRUCIANI, RICARDO MD 7/22/1954 1881615268 77 HUDSON STREET, APT. JERSEY CITY NJ 07302 DISQUALIFICATION 4/16/2018 PERMANENT 4401 CRUZ, ANGELICA CHHA 5/15/1990 2566 SOUTH 8TH STREET CAMDEN NJ 08104 DISQUALIFICATION 7/14/2017 CRUZ, DELIA CHHA 1/19/1988 3 RAY PLACE FAIRFIELD NJ 07004 DEBARMENT 3/5/2018 CRUZ, EDNA CHHA 1/27/1980 PO BOX 535 VINELAND NJ 08362 DISQUALIFICATION 1/31/2017 CRUZ, JAHAIRA CHHA 8/28/1985 559 BAILEY STREET CAMDEN NJ 08102 DISQUALIFICATION 5/2/2017 CRUZ, MARIA C. 4/21/1963 128-65 MCCARTHY CIRCLE PHILADELPHIA PA 19154 DEBARMENT 12/5/2003 CRUZ-SLEDGE, ANICIA 12/28/1961 13 TREMONT STREET, APT. 2 IRVINGTON NJ 07111 DEBARMENT 3/3/2015

CUETO, PAOLA CHHA 7/5/1994 619 THIRTY-EIGHTH STREET UNION CITY NJ 07087 DISQUALIFICATION 10/20/2017

CUFFE, MAXINE RN 9/26/1959 33 GREENBROOK DRIVE BLOOMFIELD NJ 07003 DISQUALIFICATION 3/3/2017 8/22/2019 CUI, XIN CHHA 10/17/1968 119 S. ADELAIDE LANE HIGHLAND PARK NJ 08904 DISQUALIFICATION 4/24/2008 CULLEN, CHARLES RN 2/22/1960 PO BOX 861 TRENTON NJ 08625 SUSPENSION 1/18/2007 CULLEN, KENNETH 8/16/1952 100 MARSHALL AVENUE TUCKERTON NJ 08087 SUSPENSION 1/19/2010 CUNNINGHAM, MICHAEL MD 11/10/1951 PO BOX 505 GLEN SPEY NY 12737 SUSPENSION 9/19/2002 D. CUPO, DAWN LPN 10/21/1961 129 ADELPHIA ROAD FARMINGDALE NJ 07727 SUSPENSION 6/20/2001 CUPOLO, STACY J. DENTAL 1/5/1962 897 INVERNESS COURT, APT. LAKEWOOD NJ 08701 SUSPENSION 6/20/2005 HYGIENI A ST CURETON, WILLIE T. 8/12/1969 61 CHELSEA AVENUE NEWARK NJ 07106 DISQUALIFICATION 5/27/2011 CURETON, WILLIE T. 8/12/1969 5 UNAMI LANE SCOTCH PLAINS NJ 07076 DISQUALIFICATION 2/23/2009 CURRY JR., CHARLES M. MD 6/3/1943 816 BURNT MILLS ROAD OLDWICK NJ 08858 DISQUALIFICATION 12/1/1998 CUSTIS, KEVIN MD 10/3/1964 1811976970 908 MAIN STREET ASBURY PARK NJ 07712 DISQUALIFICATION 7/22/2017 PERMANENT CUTLER, JAZMERE LPN 12/7/1994 131 HUNTLEY AVENUE BAYVILLE NJ 08721 DISQUALIFICATION 8/17/2019 CUVIELLO, CHRISTINA LPN 11/20/1978 1647 WHITTIER AVENUE TOMS RIVER NJ 08753 DISQUALIFICATION 4/24/2018 CZYZYK, LISA M. RN 2/9/1962 12 VILLAGE COURT, APT. A TRENTON NJ 08690 SUSPENSION 9/13/2013 DACONTI, JOHN DO 4/9/1947 1063460939 13 MEDFORD ROAD MORRIS PLAINS NJ 07950 DEBARMENT 6/13/2016 DAFTARY, REKHA B. MD 12/18/1953 81B EAST MAIN STREET MENDHAM NJ 07943 DISQUALIFICATION 2/29/2008

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DAHAB, YASIR 5/28/1959 5 PARK STREET ROSELAND NJ 07068 DISQUALIFICATION 12/12/2001 DAHHAN, MOHAMED Z. MD 10/28/1967 1417279779 WINDING WAY WEST PATERSON NJ 07424 SUSPENSION 11/20/2008 4/3/2014 DAILY, GALE CHHA 7/27/1959 14 SUDBERRY LANE WILLINGBORO NJ 08046 SUSPENSION 7/19/2001 DALEY, ROBERTA LPN 2/10/1957 36 HOLLY DRIVE PARLIN NJ 08859 SUSPENSION 8/20/2001 D'ALLEGRO, FRANK RPH 3/26/1928 32 SUMMIT AVENUE CEDAR GROVE NJ 07009 DISQUALIFICATION 8/5/1990 DALTON, ERIN RN 7/4/1980 14 VICTORIAN WAY WEST DEPTFORD NJ 08090 DEBARMENT 2/20/2013 10/27/2020 DALY, JAMES J. EMT 9/23/1969 504 EAST FRANKLIN AVENUE EDGEWATER PARK NJ 08010 DISQUALIFICATION 8/7/2013

DALY, LAUREN MD 3/7/1972 1952492233 SCI CAMBRIDGE SPRINGS, CAMBRIDGE SPRINGS PA 16403 DISQUALIFICATION 11/20/2015 451 FULLERTON AVENUE DALY, LAUREN MD 3/7/1972 1952492233 SCI CAMBRIDGE SPRINGS, CAMBRIDGE SPRINGS PA 16403 DISQUALIFICATION 8/5/1990 451 FULLERTON AVENUE D'AMICO, DENNIS RPH 4/12/1951 91 OTTOWA ROAD SOUTH MARLBORO NJ 08817 DISQUALIFICATION 3/11/1985 DAMMERS, SEAN 2/22/1978 255 SANTIAGO AVENUE RUTHERFORD NJ 07070 DEBARMENT 9/2/2012 DANIEL, ALAN L. LCSW 5/13/1945 415 KEIM BOULEVARD BURLINGTON NJ 08016 SUSPENSION 8/20/1999 DANIEL, ALAN L. LCSW 5/13/1945 3 HARRISON PARK LANE BURLINGTON NJ 08016 SUSPENSION 3/17/2000 DANIEL, ALAN L. LCSW 5/13/1945 202 SPRING GARDEN ROAD ANCORA NJ 08037 DISQUALIFICATION 10/20/2002 DANIEL, THERESA D. 6/6/1955 3 HARRISON PARK LANE BURLINGTON NJ 08016 SUSPENSION 3/17/2000 DANIEL-CONOVER, NAHLA CHHA 10/3/1995 191 RUTLEDGE AVENUE EAST ORANGE NJ 07017 DEBARMENT 8/1/2017 DANIELS, BERLYN E. CHHA 8/2/1965 WHITE HORSE AVENUE TRENTON NJ 08610 DISQUALIFICATION 10/13/2008 DANIELS, CLIFTON 12/7/1970 37 HUGHES STREET MAPLEWOOD NJ 07040 DEBARMENT 7/17/2009 7/17/2014 D'ANTIGNAC, CHARLOTTE 12/5/1943 3 CHURCHILL DOWNS WEST LONG BRANCH NJ 07764 SUSPENSION 3/10/2000

DARA, PARVEZ MD 4/9/1951 1215952775 214 COMMONS WAY, BLDG TOMS RIVER NJ 08755 DEBARMENT 10/12/2011 B DARBY, MARK COUNSE 8/9/1968 SBI305830E, EJSP RAHWAY NJ 07065 DEBARMENT 1/1/2010 LOR DARBY, MARK COUNSE 8/9/1968 SBI305830E, EJSP RAHWAY NJ 07065 DEBARMENT 11/18/2010 LOR D'ASCOLI, MD 6/3/1949 PO BOX 1869 MONTAGUE NJ 07827 DEBARMENT 8/18/2000 BARTHOLOMEW DASS, SUMAN K. MD 10/13/1930 4 BALDWIN AVENUE JERSEY CITY NJ 07304 DEBARMENT 10/4/2000

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DATCHER, ANTHONY 1/31/1984 SCI DALLAS, FOLLIES ROAD, DALLAS PA 18612 DISQUALIFICATION 11/20/2015 DRAWER K DATESHIDZE, JANE RPH 4/2/1970 617 STOKES ROAD, SUITE 4 MEDFORD NJ 08055 DEBARMENT 6/28/2017 DATILUS, SHELSIE CHHA 3/25/1989 533 NORWOOD STREET, FL. 1 EAST ORANGE NJ 07018 DISQUALIFICATION 8/22/2017 PERMANENT

DAVID, RICHARD 3/3/1961 819 EDGEWOOD AVENUE TRENTON NJ 08618 DEBARMENT 9/17/2009 2/17/2016 DAVID, VANESSA LPN 10/27/1980 204 N. 17TH STREET BLOOMFIELD NJ 07003 DISQUALIFICATION 12/17/2018 DAVIS, ANTOINETTE 6/21/1968 43 VERNON COURT SICKLERVILLE NJ 08081 DISQUALIFICATION 4/23/2007 DAVIS, CHARLES M. COUNSE 9/18/1950 1902045511 381 BALA AVENUE BALA CYNWYD PA 19004 SUSPENSION 3/31/2008 LOR DAVIS, CONITA CHHA 7/4/1972 2 SUTTON DRIVE, APT. O-1 MATAWAN NJ 07747 DISQUALIFICATION 8/7/2017 DAVIS, COREY 3/20/1969 25 JAMES STREET LAKEWOOD NJ 08701 DISQUALIFICATION 3/12/2006 DAVIS, DEYSHA 12/15/1972 12250 ATLANTIC BOULEVARD JACKSONVILLE FL 32225 DISQUALIFICATION 11/20/2015 #1701 DAVIS, ESTELLE CHHA 8/11/1974 71 HAMILTON STREET EAST ORANGE NJ 07017 DEBARMENT 5/31/2018 DAVIS, JAMES DANIEL 1/17/1961 145 JUNIPER STREET BROWNS MILLS NJ 08015 DISQUALIFICATION 10/4/1988 DAVIS, JAMES S. 11/12/1963 41 B TROY DRIVE SPRINGFIELD NJ 07081 DISQUALIFICATION 9/4/1986 9/4/1994 DAVIS, JEFFREY J. MD 3/26/1948 1548258189 5 E. 63RD STREET NEW YORK NY 10065 DISQUALIFICATION 11/22/2016 DAVIS, KARIN B. RN 4/15/1971 141 EAST BENNETT AVENUE WILDWOOD NJ 08260 SUSPENSION 10/20/2002 4/14/2014

DAVIS, LORETTA CHHA 7/26/1973 120 CENTRAL PLACE, 202B ORANGE NJ 07050 DEBARMENT 1/19/2018 DAVIS, MARK S. DPM 5/23/1965 5 MONTANA DRIVE COLTS NECK NJ 07722 SUSPENSION 4/9/2004 DAVIS, MD 9/23/1926 230 W. JERSEY STREET ELIZABETH NJ 07202 DISQUALIFICATION 6/13/1985 MATILDA/MATHILDA DAVIS, NICOLE RN 3/23/1978 544 ACKLEY ROAD NEWPORT NJ 08345 DISQUALIFICATION 6/4/2018 DAVIS, SHANTA LPN 12/4/1973 114 PLUMTREE LANE WILLINGBORO NJ 08046 DISQUALIFICATION 5/11/2019 DAVIS, SHARAE CHHA 7/24/1985 116 LANFORD STREET ASBURY PARK NJ 07712 DISQUALIFICATION 1/31/2017 DAVIS-HARVEY, DIANA RN 3/12/1984 10 CAMINO COURT SICKLERVILLE NJ 08081 DEBARMENT 9/15/2017 8/6/2021 DAVIT, SAMUEL MD 7/3/1952 100 WINSTON DRIVE #B CLIFSIDE PARK NJ 07010 SUSPENSION 4/20/2003 DAWLEY, ASHALEY CHHA 3/12/1996 247 MORSE STREET CAMDEN NJ 08105 DISQUALIFICATION 4/19/2018 DAWOUD, MONIR A. MD 12/1/1939 7 COLTSFOOT GLEN SADDLE RIVER NJ 07458 SUSPENSION 11/13/2008 DAWOUD, MONIR A. MD 12/1/1939 7 COLTSFOOT GLEN SADDLE RIVER NJ 07458 DISQUALIFICATION 9/4/2007 DAWSON, LATIA CHHA 5/27/1989 838 4TH AVENUE NEPTUNE NJ 07753 DISQUALIFICATION 7/14/2017 11/9/2020

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DE LA ROSA ACOSTA, CHHA 6/15/1969 355 OAK STREET, APT. 8 PASSAIC NJ 07055 DISQUALIFICATION 1/31/2017 BIENVENIDA DEAN, ARLENE CHHA 6/3/1948 34 WEST UNION STREET, BURLINGTON NJ 08016 DISQUALIFICATION 7/3/2019 APT. A DEAN, RANDY MD 5/7/1956 1083924807 3991 NORTH WEST 99TH CORAL SPRING FL 33065 DISQUALIFICATION 11/20/2015 AVENUE DEANGELO, KRYSTAL RN 7/23/1989 1314 HANCOCK AVENUE VANDERGRIFT PA 15690 DISQUALIFICATION 11/20/2015 DEAQUINO, ANTHONY 3/31/1943 11 STONE RIDGE LANE HO-HO-KUS NJ 07423 DEBARMENT 12/19/2002 DEBARO, GERRI RN 7/19/1985 3715 ROYCE COURT HILLSBOROUGH NJ 08844 DISQUALIFICATION 3/12/2019 DEBIASI, RICK DC 3/23/1964 1861415655 1 ASHLEY PLACE TOWACO NJ 07082 DEBARMENT 6/30/2016 DECASTRO, ANGELA LPN 2/6/1960 894 GOSHEN ROAD CAPE MAY COURT NJ 08210 DISQUALIFICATION 8/29/2016 HOUSE DEEMI, SAMUEL 8/19/1965 665 MARTIN LUTHER KING NEWARK NJ 07102 DISQUALIFICATION 10/27/2010 BOULEVARD DEFEO, DELORES A. CNA 4/27/1947 RR #6 BOX 280-D PLEASANTVILLE NJ 08232 DISQUALIFICATION 4/26/1996 DEGILIO, MICHAEL PSYD 9/21/1968 1356329528 144 DOGWOOD DRIVE JIM THORPE PA 18229 DISQUALIFICATION 11/20/2015 DEGUZMAN, DAISY MD 1/28/1943 1699865097 111 MULBERRY STREET NEWARK NJ 07102 DISQUALIFICATION 2/20/2014 9/22/2020 DEIXLER, GLENN CHHA 9/14/1957 262 PRIVATEER ROAD MANAHAWKIN NJ 08050 DISQUALIFICATION 4/19/2018 DEJESUS, YAZMIN CHHA 7/4/1982 654 OHIO AVENUE EWING NJ 8638 DISQUALIFICATION 7/19/2019 DEKU, FAUSTINA CHHA 2/7/1976 10 MARSHALL STREET IRVINGTON NJ 07111 DISQUALIFICATION 2/8/2017 DEL PIANO, ANTHONY MD 3/9/1960 1922032770 24 DRINKING BROOK ROAD MONMOUTH NJ 08052 DISQUALIFICATION 10/15/2015 JUNCTION DELA GENTE, ROBERT AKA MD 4/12/1974 1891886230 12 HUNTERS RUN OAKLAND NJ 07436 DISQUALIFICATION 6/12/2019 DELAGENTE, ROBERT

DELACRUZ, AMELITA CHHA 3/27/1966 62 LEXINGTON AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 6/28/2018 DELAGENTE, ROBERT AKA MD 4/12/1974 1891886230 12 HUNTERS RUN OAKLAND NJ 07436 DISQUALIFICATION 6/12/2019 DELA GENTE, ROBERT

DELGADO, NICOLE RN 6/21/1990 81 WALNUT STREET OAKLAND NJ 07436 DISQUALIFICATION 1/29/2018 DELGADO, YOKATI CHHA 6/28/1976 175 BRIGHTON AVENUE PERTH AMBOY NJ 08861 DISQUALIFICATION 1/31/2017 DELIA, MICHELLE 3/5/1989 545 W. HILL ROAD GLEN GARDNER NJ 08826 DISQUALIFICATION 4/7/2010 DELLAPENNA, LINDA CNA 11/7/1969 52 VAN NESS DRIVE BRICK NJ 08723 DISQUALIFICATION 11/13/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DELOACH, LORRAINE CHHA 7/24/1964 9 DAVID STREET, APT. 3 SOUTH RIVER NJ 08882 DISQUALIFICATION 1/31/2017 DELUANTO, LILIANA CHHA 12/10/1993 1160 SUMMIT LANE MOUNTAINSIDE NJ 07092 DISQUALIFICATION 7/2/2018 DELUCA, ANTHONY MD 9/4/1962 1043257744 630 PRINCETON AVENUE BRICK NJ 08724 DISQUALIFICATION 12/16/2015 DELUCA, ANTHONY MD 9/4/1962 1043257744 630 PRINCETON AVENUE BRICK NJ 08724 DEBARMENT 2/11/2016 DELUCA, WENDY RN 10/4/1957 108 GRANDVIEW ROAD HIGHLAND LAKES NJ 07422 DISQUALIFICATION 3/15/2018 DEMARCO, CHARLENE C DO 4/8/1951 PO BOX 898801 OKLAHOMA CITY OK 73189 SUSPENSION 7/20/2008 DEMARIA JR., WILLIAM R. 11/1/1959 104 WINDSOR COURT PALM BEACH FL 33480 DEBARMENT 1/5/2001 DEMASSI, MICHAEL A. LCSW 3/6/1969 1917 WATERS EDGE DRIVE TOMS RIVER NJ 08753 DISQUALIFICATION 12/20/2013 DEMEO, ROBERT MD 5/12/1945 1043220262 522 TYSENS LANE, 2ND FL. STATEN ISLAND NY 10306 DISQUALIFICATION 2/23/2015 DEMOSS, KATHLEEN M. DC 7/8/1967 14 N. MAIN STREET FLEMINGTON NJ 08822 SUSPENSION 6/19/2001 DENNIS, MOSES LPN 5/19/1981 625 GREENWAY AVENUE DARBY PA 19023 DISQUALIFICATION 6/18/2018 DENUCCI, NICHOLAS 7/22/1965 51 BARN OWL HACKETTSTOWN NJ 07840 DISQUALIFICATION 7/24/2002 DEORIO, ANA G. RN 10/3/1974 COLUMBIA AVENUE NORTH BERGEN NJ 07047 SUSPENSION 10/18/2007 DEROSIER-BEAUBRUN, CHHA 12/11/1982 954 SOUTH BROAD STREET TRENTON NJ 08611 DISQUALIFICATION 6/28/2018 SABRINA DERRICK, NAOMI AKA RN 5/5/1975 6 ENGLISH IVY DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 12/26/2016 BASCUS, NAOMI DERRICK, NAOMI AKA RN 5/5/1975 6 ENGLISH IVY DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 4/9/2020 BASCUS, NAOMI DESAI, BAKUL MD 12/29/1952 1376654624 15 MOUNTAIN RIDGE DRIVE LIVINGSTON NJ 07039 SUSPENSION 3/8/2010 9/10/2019

DESAI, BAKUL MD 12/29/1952 1376654624 15 MOUNTAIN RIDGE DRIVE LIVINGSTON NJ 07039 DISQUALIFICATION 9/20/2012 9/10/2019

DESAI, NEMISH DDS 6/29/1966 1598908295 348 BOONTON TURNPIKE LINCOLN PARK NJ 07035 DISQUALIFICATION 5/18/2019 DESANTIS, ANTHONY C. RPH 2/18/1926 105 FRANKLIN STREET BELLEVILLE NJ 07109 DEBARMENT 2/24/2003 DESIMONE, EUGENE MD 10/25/1953 1427098268 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 10/28/2015 DESIR, MELISSA CHHA 6/24/1989 20 WILLOW DRIVE, APT. 8 OCEAN NJ 07712 DISQUALIFICATION 4/18/2017 DESTASIO, VINCENT MD 8/20/1961 1043215650 1851 HOOPER AVENUE TOMS RIVER NJ 08753 SUSPENSION 4/12/2016 5/13/2016 DESTASIO, VINCENT MD 8/20/1961 1043215650 1851 HOOPER AVENUE TOMS RIVER NJ 08753 DEBARMENT 5/13/2016 DETROLIO, DANIEL RN 7/13/1981 23 FOXWOOD DRIVE, APT. D MORRIS PLAINS NJ 07950 DISQUALIFICATION 3/27/2018

DEVARIS, HELENA D. DMD 8/8/1955 1679723589 35-08 MORLOT AVENUE 1X FAIR LAWN NJ 07410 SUSPENSION 5/21/2013 DEVARSO, ANGELA RN 8/15/1976 FCI DANBURY, RT 37 DANBURY CT 06811 DEBARMENT 5/20/2012 DEVERA, MONICA T. 5/4/1945 118 BEACON STREET DUMONT NJ 07628 SUSPENSION 8/20/2002

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DEVLIN, MARYELLEN RN 1/21/1959 809 DEVON ROAD RIVERSIDE NJ 08075 DISQUALIFICATION 6/4/2018 PERMANENT DEZENHALL, MERVIN RPH 11/27/1930 SUNSET ROAD AT SUMMIT WILLINGBORO NJ 08046 DISQUALIFICATION 6/1/1993 TURN DI SPALTRO, FRANKLIN L. MD 5/28/1940 1740627082 MELROSE LANE GREEN VILLAGE NJ 07935 SUSPENSION 10/18/2007 DIAZ, CHRISTINA CHHA 2/13/1987 40 MORRIS STREET, APT. 402 PASSAIC NJ 07055 DISQUALIFICATION 2/22/2019

DIAZ, PEDRO P. 1/18/1930 80 SKYTOP ROAD NEWTON NJ 07860 DISQUALIFICATION 5/20/2011 DIAZ-PELLOT, NORMA 10/31/1959 500 BERKELY DRIVE BROWNS MILLS NJ 08015 DISQUALIFICATION 3/24/2000 DIAZ-PELLOT, NORMA 10/31/1959 258 UNIVERSITY AVENUE PEMBERTON NJ 08068 DISQUALIFICATION 7/19/2001 DICARLO, ANTHONY G. 12/21/1936 35 GALT OCEAN DRIVE FT LAUDERDALE FL 33308 DISQUALIFICATION 6/1/1993 DICICCO, RICHARD DC 9/28/1963 1073668265 1 MYERS AVENUE BERLIN NJ 08009 DISQUALIFICATION 6/5/2017 DICK, SHONDELL CHHA 4/29/1992 196 22ND STREET IRVINGTON NJ 07111 DISQUALIFICATION 1/29/2018 PERMANENT DICKERSON, DENISE M. RN 6/12/1954 126 HILLCREST AVENUE, 2A BLACKWOOD NJ 08012 DISQUALIFICATION 9/22/2010 DICOVSKIY, CLAUDIO MD 6/22/1962 1932282845 1308 ABBOTT BOULEVARD FORT LEE NJ 07024 DISQUALIFICATION 8/7/2017 DICOVSKIY, CLAUDIO MD 6/22/1962 1932282845 1308 ABBOTT BOULEVARD FORT LEE NJ 07024 DISQUALIFICATION 2/23/2015 DICUBELLIS, MICHELE R. LCSW 4/8/1954 4030 ANDERSON AVENUE, SE ALBUQUERQUE NM 87108 DISQUALIFICATION 6/23/2011 10/22/2014

DIEM, MICHELLE C. CHHA 4/18/1990 821 NEVILLE STREET TOMS RIVER NJ 08753 DEBARMENT 9/23/2014 DIETERLE, KAREN M. RN 5/31/1960 51 STURBRIDGE DRIVE SICKLERVILLE NJ 08081 SUSPENSION 8/19/2004 DIETRICH, LISA B. AKA MD 4/2/1967 DOGWOOD TRAIL RANDOLPH NJ 07869 SUSPENSION 11/20/2008 LOWELL-SENTURIA, LISA DIETZ, MICHAEL CHHA 2/1/1989 1602 AQUEDUCT COURT TOMS RIVER NJ 08755 DISQUALIFICATION 2/20/2017 DIGIORGIO, DAWN K. 10/16/1967 13 EAST PINE STREET 13D WESTVIEW NJ 08093 SUSPENSION 2/19/2004 DIKENGIL, MEHMET DDS 3/15/1948 1255608279 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 10/10/2019 #79773-054 DILLARD, LATICIA 3/5/1977 4208 NORTH DRIVE ATLANTIC CITY NJ 08401 DEBARMENT 8/24/2013 DILLIGARD, LATASHA CHHA 10/24/1991 320 W. BRANCH AVENUE, CAMDEN NJ 08021 DISQUALIFICATION 2/8/2017 APT. 47C DILORENZO, PAUL MD 2/7/1954 1699841056 22 NORTHWOODS ROAD OCEAN NJ 07712 DISQUALIFICATION 4/17/2017 DILUIGI, KENNETH RN 11/21/1958 RAVENSWOOD WAY SEWELL NJ 08080 DEBARMENT 12/17/2008 DIMEO, ALEXANDER DC 5/22/1954 19355 LASERNA DRIVE FORT MEYERS FL 33967 DISQUALIFICATION 3/3/2017 DINKEL, ARTHUR R. LCSW 11/9/1945 2 FREEMAN LANE DENVILLE NJ 07834 DEBARMENT 9/29/2000 DINKEL, ARTHUR R. LCSW 11/9/1945 2 FREEMAN LANE DENVILLE NJ 07834 DISQUALIFICATION 4/19/2001 DIPAOLO, EDMONDO LPN 7/5/1969 136 DANIELS AVENUE BROWNS MILLS NJ 08015 DISQUALIFICATION 5/9/2020

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DIRENZO, ALFRED M. DO 11/3/1934 167 GROVE STREET LODI NJ 07644 DISQUALIFICATION 2/21/1995 DISCENZA, RONALD MD 6/21/1954 1528137882 2578 WOLF HOLLOW ROAD ANDES NY 13731 DISQUALIFICATION 4/17/2017

DITA, INC. 500 ORANGE STREET NEWARK NJ 07104 SUSPENSION 2/18/1998 DITURO, JOSEPH MD 3/2/1952 1194871459 376 WOOD RIDGE AVENUE WOOD RIDGE NJ 07075 DEBARMENT 2/15/2016 DIXIT, DIVY R. RPH 8/25/1969 1619125135 3022 EDWARD STEC EDISON NJ 08837 DISQUALIFICATION 4/30/2015 BOULEVARD DIXON, SHANNON 2/11/1984 501 IRVING STREET CLEMENTON NJ 08021 DEBARMENT 3/18/2010 3/18/2013 DJAMBA, MONDJA CHHA 4/2/1987 17 PHEASANT ROAD CLEMENTON NJ 08021 DISQUALIFICATION 12/6/2017 PERMANENT DJAVID, ISMAIL F. 4/10/1908 160 EAST 89TH STREET NEW YORK CITY NY 10028 DISQUALIFICATION DLUZNIEWSKI, MICHELE RN 1/31/1989 137 STEPHAN ROAD BRICK NJ 08724 DISQUALIFICATION 2/7/2019 DOBROWOLSKI, DONALD DMD 6/17/1955 1184764664 45 BRICK BOULEVARD S-108 BRICK NJ 08723 DISQUALIFICATION 12/29/1995

DOLINER, PAUL MD 12/3/1927 401 US HIGHWAY 22 NORTH PLAINFIELD NJ 07060 DISQUALIFICATION 9/15/1980 DOMINIC JR., ANTHONY J. MD 4/27/1951 216 2ND AVENUE UPPER MANASQUAN NJ 08736 SUSPENSION 1/20/2002

DONALDSON, DENISE RN 1/26/1958 53 3RD AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 7/9/2003 DECEASED DONALDSON, DENISE RN 1/26/1958 2650 SPRUCE DRIVE LAKEHURST NJ 08733 DISQUALIFICATION 12/29/1995 DECEASED DONOFRIO, CHRISTINE RN 8/14/1965 207 TULIP LANE FREEHOLD NJ 07728 DISQUALIFICATION 8/3/2017 DONOFRIO, DOUG 8/11/1965 1 SPRING LAKE DRIVE FAR HILLS NJ 07931 DISQUALIFICATION 1/4/2012 DOOLEY, CHRISTOPHER J. PHD 9/6/1950 10 DEER RUN FREEHOLD NJ 07728 SUSPENSION 2/9/2009 DORBOR, BONGO CHHA 4/1/1977 2341 LIBERTY STREET HAMILTON NJ 08629 DISQUALIFICATION 2/20/2017 DORIA, LAWRENCE RPH 4/26/1937 6 BROOK PLAZA JACKSON NJ 08527 DISQUALIFICATION 2/7/1984 DORSEY, KIONA CHHA 3/31/1994 670 W. GROVELAND AVENUE SOMERS POINT NJ 08244 DISQUALIFICATION 7/22/2019

DORVIL, FAUBERT RN 3/5/1962 651 S. PALM STREET, #201 LITTLE ROCK AR 72205 DISQUALIFICATION 7/4/2014 DOSHI, PRIYAKANT S. MD 3/4/1942 11 WARFIELD STREET MONTCLAIR NJ 08625 DISQUALIFICATION 12/2/1997 DECEASED DOSSEN, SEBRENA CHHA 9/9/1990 24 PHILLIP E. FRANK WAY CLIFFWOOD NJ 07721 DISQUALIFICATION 1/29/2018 DOSSOUS, JONAS CHHA 2/2/1977 1927 BANGS AVENUE NEPTUNE NJ 07753 DISQUALIFICATION 10/17/2017 DOTOLI, FRANKLIN MD 7/1/1924 460 FRANKLIN AVENUE NUTLEY NJ 07110 DISQUALIFICATION 6/1/1993 DECEASED DOTRO, ALYCIA AKA RN 5/9/1975 6 LOWELL ROAD MANALAPAN NJ 07726 DISQUALIFICATION 11/23/2019 ALEXANDRA, ALYCIA D'OTTAVIO, PAOLA RPH 8/29/1966 504 WILLOW OAK DRIVE MAYS LANDING NJ 08330 SUSPENSION 6/4/2007 D'OTTAVIO, PAOLA RPH 8/26/1966 504 WILLOW OAK DRIVE MAYS LANDING NJ 08330 DISQUALIFICATION 9/20/2011

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE DOUGHERTY-PRICE, CHHA 3/31/1954 212 WESTMONT AVENUE WESTMONT NJ 08108 DISQUALIFICATION 5/22/2017 ANITA JO DOWNTOWN DENTAL 1 WEST BROADWAY PATERSON NJ DISQUALIFICATION 2/20/2001 CENTER DOYLE, JUDITH M. RN 11/15/1969 71 WILDFLOWER LANE MORRISTOWN NJ 07960 DEBARMENT 10/20/2004 10/27/2017 DRAGERT, ROBERT MD 1/23/1970 1558522821 12 E. SEUDDER COURT PENNINGTON NJ 08534 DEBARMENT 9/26/2018 7/21/2020 DRIVAS, GUSTAVE S. MD 6/19/1955 1003867730 FCI LORETTO LORETTO PA 15940 DISQUALIFICATION 5/11/2014 DRIZAN, LOULEA CHHA 12/27/1978 43B MANLAY MANOR ELIZABETH NJ 07202 DISQUALIFICATION 3/6/2018 DUAH, GLORIA CHHA 7/7/1986 68 MYRTLE AVENUE IRVINGTON NJ 07111 DEBARMENT 2/20/2017 DUARTE, LEONARD DC 7/21/1951 1568681542 10 INDEPENDENCE COURT JACKSON NJ 08527 DISQUALIFICATION 8/30/2019 DUBNOFF, MICHELLE DC 8/4/1969 1225066210 333 PROVINCIAL DRIVE MORGANVILLE NJ 07751 DISQUALIFICATION 6/20/2018 DUBOVY, CARL MD 6/28/1933 11 PIPPINS WAY MORRISTOWN NJ 07960 DISQUALIFICATION 12/1/1998 DUCHEINE, YVAN MD 6/16/1963 1578638136 310 CENTRAL AVENUE EAST ORANGE NJ 07018 DEBARMENT 11/1/2017 4/5/2018 DUFF, RICHARD W. RN 3/8/1966 1260 SUMMERLEA AVENUE WASHINGTON PA 15301 DISQUALIFICATION 12/29/2015 DUFFIELD, CAMI R. RN 8/27/1970 119 GRAF AVENUE LAWRENCEVILLE NJ 08648 SUSPENSION 12/20/2000 DUFFY, BARBARA AKA LPN 3/29/1964 208 WAYNE TERRACE COLLINGSWOOD NJ 08108 SUSPENSION 8/19/2004 GONZOPH, BARBARA DULL, JOHN W. DDS 1/11/1955 399 HOOVER AVENUE BLOOMFIELD NJ 07003 DISQUALIFICATION 12/1/1998 DECEASED DUMITRU, DAN MD 11/27/1970 1073639530 1657 JFK BOULEVARD, FL 1 JERSEY CITY NJ 07305 DEBARMENT 1/11/2016 DUQUE, IRMA CHHA 12/19/1949 314 BROADWAY ELIZABETH NJ 07206 SUSPENSION 5/14/2007 DURFEE, JANET RN 1/31/1953 103 WOODLAKE DRIVE MARLTON NJ 08053 SUSPENSION 7/20/2004 DURIVAGE, SHARON RN/APN 7/14/1963 1407033442 1655 HUNTERS COURT YARDLEY PA 19067 DISQUALIFICATION 6/4/2018 DURNIEN, EDWARD CHHA 12/21/1971 215 CREEK ROAD KEANSBURG NJ 07734 DISQUALIFICATION 1/6/2006 DURST, LAWRENCE RPH 1/1/1950 FCI FORT DIX, PO BOX 38 FORT DIX NJ 08640 SUSPENSION 6/19/2001 DYEVICH, KEVIN J. 1/16/1962 193 LIVINGSTON AVENUE NEW BRUNSWICK NJ 08901 DISQUALIFICATION 8/21/1996 DYOUS, KEISHA LPN 1/8/1972 2 BONNIE COURT LAWRENCEVILLE NJ 08648 DISQUALIFICATION 4/24/2018 8/22/2019 DZIENISIEWSKI, DONNA J. RN 11/22/1973 9 IVY LANE MIDDLETOWN NJ 07748 DISQUALIFICATION 6/3/2016 DZUIK, CAROL CHHA 2/23/1958 416 CABLE AVENUE BEACHWOOD NJ 08722 DISQUALIFICATION 2/8/2017 EASTBURN, NORMAN W. DC 10/21/1965 1013056670 424 MATTHEWS LANE JACKSON NJ 08527 DISQUALIFICATION 11/14/2014 EASY DENTAL PC 1093093585 5616 GERMANTOWN PHILADELPHIA PA 19114 DISQUALIFICATION 11/20/2015 AVENUE EATOUGH, PHILIP DO 1/15/1947 1972681674 5 SYCAMORE LANE RUMSON NJ 07748 DISQUALIFICATION 2/26/2010 EDANIEWSKI, EDWARD R. 113 FRONT STREET SECAUCUS NJ 07094 DISQUALIFICATION EDMILAO, CANUNITA 645 NEWARK AVENUE JERSEY CITY NJ 07305 SUSPENSION 4/9/2004

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE EDMONDS, KIANNAH CHHA 8/21/1994 916 4TH AVENUE WALL TOWNSHIP NJ 07719 DEBARMENT 12/6/2017 EGANEY, BETH LPN 9/23/1972 46 REA AVENUE MIDLAND PARK NJ 07432 DISQUALIFICATION 10/28/2019 EGBERT, JENNIFER CHHA 3/5/1979 PO BOX 1129 FORKED RIVER NJ 08731 DISQUALIFICATION 12/26/2018 EGENBERG, IRIS 12/12/1955 153 AVENUE "B" BAYONNE NJ 07002 DISQUALIFICATION EGLOFF, MARY ANN RN 7/9/1946 1100 KELLY LANE FARMINGDALE NJ 07727 SUSPENSION 5/19/2005 EICHHORN, WARREN DC 3/1/1985 1326412297 447 NEW ROAD SOUTHAMPTON NJ 08088 DISQUALIFICATION 2/28/2019 EIDMAN, STEVEN DDS 10/12/1956 73 E. LINCOLN AVENUE ENGLEWOOD NJ 07631 SUSPENSION 1/19/2003 EISEMANN, OSHER 10/2/1956 345 OAK STREET LAKEWOOD NJ 08701 SUSPENSION 7/23/2018 EJIOFOR, UDOKA RN/APN 3/23/1963 1295096584/ 47 KENMORE AVENUE NEWARK NJ 07106 DEBARMENT 4/26/2018 10/20/2020 EKSTEROWICZ, DEBORAH LPN 6/6/1954 283 S. BLACKHORSE PIKE MOUNT EPHRIAM NJ 08059 SUSPENSION 7/18/2002

EL SOURY, AHMED MD 8/11/1972 1497745905 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 4/4/2018 #70613-050 ELAMIR, MAGDY MD 4/17/1953 1710081336 14 HIGH MEADOW ROAD N SADDLE RIVER NJ 07458 DEBARMENT 3/18/2015 ELAMIR, MAGDY MD 4/17/1953 1710081336 550 SUMMIT AVENUE JERSEY CITY NJ 07306 DEBARMENT 11/5/2010 ELBASHIR, IMAD 1/1/1961 160 ALABAMA AVENUE PATERSON NJ 07505 SUSPENSION 1/28/2001 MAHGOUB ELBASHIR, IMAD 1/1/1961 PO BOX 7450 TRENTON NJ 08628 SUSPENSION 6/17/2004 MAHGOUB ELCHAGEA, ISMAIL 10/21/1951 470 CHAMBERLAIN AVENUE PATERSON NJ 07522 DEBARMENT 7/1/2000

ELHAG, ABUBAKER O. 1/19/1962 10 HILL STREET APT. 9W NEWARK NJ 07102 DEBARMENT 11/23/2007 ELIA, HARRY R. DC 5/11/1953 1104034578 136 BROADWAY WESTWOOD NJ 07675 DISQUALIFICATION 12/1/1998 ELIA-RAGGIO, LORI LPN 2/21/1961 4001 BURRYPORT WAY MOUNT LAUREL NJ 08054 SUSPENSION 3/18/2004 ELLIEN, WILLIAM MD 6/19/1955 1437196375 39 CABBAGE XING SAVANNAH GA 31411 DISQUALIFICATION 11/20/2015 ELLIOTT, CLAUDIA CHHA 5/3/1974 345 PARK AVENUE, APT. 4 PATERSON NJ 07504 DEBARMENT 9/26/2017 ELLIS, KENT R. MD 12/1/1952 1005 N. WASHINGTON GREEN BROOK NJ 08812 DEBARMENT 6/15/2001 AVENUE ELLISON, RAEFORD LAC 10/19/1952 8 N. SACRAMENTO AVENUE VENTNOR NJ 08406 SUSPENSION 4/18/2002

EMERSON, BARBARA L. RN 9/6/1972 45 HAWTHORNE STREET BROWNS MILLS NJ 08015 SUSPENSION 5/20/2004 EMMERICH, MICHELE 9/14/1965 1306342373 200 ROUND HILL DRIVE FREEHOLD NJ 07728 SUSPENSION 4/29/2019 8/2/2021

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ENEMUO, JOHNNY 10/15/1966 215 JACOBY STREET, 1ST MAPLEWOOD NJ 07040 DISQUALIFICATION 5/1/1999 FLOOR ENEMUO, KENNETH O. RPH 3/30/1962 236-242 S. ORANGE AVENUE NEWARK NJ 07103 DISQUALIFICATION 3/20/1999 10/26/2017

ENGRISSEI, PATRICIA RN 10/6/1953 700 GROVE STREET HADDONFIELD NJ 08033 SUSPENSION 8/18/2005 ENOGWE, FELIX RPH 3/25/1953 51 CLIFTON AVENUE, C-401 NEWARK NJ 07104 DISQUALIFICATION 5/24/1999 ENOGWE, FELIX RPH 3/25/1953 25 CLIFTON AVENUE NEWARK NJ 07104 DEBARMENT 2/24/2006 ENRICO JR., ANTHONY DPM 8/12/1957 1013095975 57 STONEYRIDGE DRIVE LINCOLN PARK NJ 07035 DISQUALIFICATION 5/2/2017 ENRICO JR., ANTHONY DPM 8/12/1957 1013095975 99 SUNCREST AVENUE NORTH HALEDON NJ 07508 DEBARMENT 2/8/2017 ENRICO JR., ANTHONY DPM 8/12/1957 1013095975 USP LEWISBURG, PO BOX LEWISBURG PA 17837 DISQUALIFICATION 2/5/2019 1000 ERKOBONI, PATRICIA RN 6/25/1964 1850 W. MCGALLIARD TRENTON NJ 08610 DISQUALIFICATION 5/14/2018 AVENUE ERNST, DAVID J. DDS 7/7/1955 5 BRUNSWICK WOOD DRIVE EAST BRUNSWICK NJ 08816 DISQUALIFICATION 3/31/1995

ESCALERA, EMILY CHHA 11/5/1993 3716 UNION AVENUE, APT. B PENNSAUKEN NJ 08109 DISQUALIFICATION 7/2/2018

ESPADA, MARGARET CHHA 12/3/1976 310 HAMILTON AVENUE SEASIDE HEIGHTS NJ 08751 DISQUALIFICATION 2/8/2017 ESPINDOLA, JUAN MD 2/2/1958 1881703726 467 CLIFTON AVENUE CLIFTON NJ 07011 SUSPENSION 8/29/2016 4/1/2017 ESPINDOLA, JUAN MD 2/2/1958 1881703726 32 FOREST STREET MONTCLAIR NJ 07042 DEBARMENT 4/1/2017 ESPINDOLA, JUAN MD 2/2/1958 1881703726 32 FOREST STREET MONTCLAIR NJ 07042 DISQUALIFICATION 3/1/2019 ESPOSITO, VINCENT A. MD 12/19/1957 1225008253 5 BUCKINGHAM DRIVE MADISON NJ 07940 DISQUALIFICATION 7/20/2017 ESQUERRE, RENE MD 12/25/1951 1033150172 5 ASHLEY ROAD WEST ORANGE NJ 07052 DEBARMENT 7/18/2018 11/8/2018 ESSER, ARISTIDE HENRI PSY 5/11/1930 1447249891 337 N. MAIN STREET STE 2 NEW CITY NY 10956 SUSPENSION 10/20/2013 ESTAMBUL, BERNARDO 11/10/1948 605 W. 141ST STREET, APT NEW YORK NY 10031 DEBARMENT 1/31/2008 51 ESTERMAN, SIDNEY N. DPM 5/20/1932 185 CENTRAL AVENUE, STE. EAST ORANGE NJ 07019 DISQUALIFICATION 8/31/2001 412 ETIENNE, FERNANDE CHHA 11/18/1963 1205 MORRIS STREET #2L ROSELLE NJ 07203 SUSPENSION 3/20/2006 EUSEBIO, EDWIN CHHA 4/3/1993 220 S. 30TH STREET CAMDEN NJ 08105 DISQUALIFICATION 1/31/2017 EVANS JR., EUGENE MD 7/26/1958 1033284930 301 EAST LINCOLN AVENUE ROSELLE PARK NJ 07204 DISQUALIFICATION 2/9/2017 EVANS, ROLAND A. DC 6/15/1967 263 NORTH 3RD AVENUE MANVILLE NJ 08835 DISQUALIFICATION 9/3/2003 EVDOKIMOW, DAVID MD 3/23/1960 1508930678 528 TEMPE WICK ROAD HARDING NJ 07960 DISQUALIFICATION 4/12/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE EVRA, JOANEL CHHA 5/6/1986 1551B ASBURY AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 8/29/2017 EWING, DIONNA CHHA 12/4/1987 909 HADDON AVENUE CAMDEN NJ 08103 DEBARMENT 7/2/2018 EZELL, PAUL MD 2/28/1956 1235130741 251 SAGAMORE ROAD HAVERTOWN PA 19083 DISQUALIFICATION 11/20/2015 EZEONYIM, CHARLES I. RPH 2/24/1961 2153 TYLER STREET UNION NJ 07083 DEBARMENT 1/16/2009 1/6/2012 FABULIAN, PETER DO 11/9/1947 1023184835 26 WEST MAIN STREET STRASBURG PA 17579 DISQUALIFICATION 2/20/2013 FAENZA, MATTHEW RPH 9/22/1938 64 COVENTRY WAY RINGWOOD NJ 07456 SUSPENSION 1/20/2004 FAERMAN, VLADIMIR CHHA 11/20/1947 2506 GATES COURT MORRIS PLAINS NJ 07950 DISQUALIFICATION 6/16/2017 FAHE, MIREILLE RN 5/3/1976 269 MAIN STREET, APT. B NEW MILFORD NJ 07646 DISQUALIFICATION 3/3/2017 10/24/2018 FAISON, LAUREN 3/19/1973 1804 EAST THAYER STREET PHILADELPHIA PA 19134 DISQUALIFICATION 11/20/2015 FAKONDO, VICTOR H. RPH 10/19/1956 180 HANSON AVENUE PISCATAWAY NJ 08854 DISQUALIFICATION 8/18/2011 FALLAH, KEBEH CHHA 1/1/1994 365 SCHLEY STREET, APT. A8 NEWARK NJ 07112 DISQUALIFICATION 7/14/2017 6/12/2018

FALLUCCA, KARLA JANE APN/RN 2/5/1985 1053734095 21 STONEHAM DRIVE DELRAN NJ 08075 DEBARMENT 10/20/2020 FALOWO, YETUNDE 2/16/1972 301 MAPLE AVENUE, APT. NORTH PLAINFIELD NJ 07060 DISQUALIFICATION 1/6/2006 266 FAMILY ENRICHMENT 415 KEIM BOULEVARD BURLINGTON NJ 08016 SUSPENSION 8/20/1999 INSTITUTE FARL, MUTALIB CHHA 3/15/1979 61 NORTH ARLINGTON EAST ORANGE NJ 07017 DISQUALIFICATION 7/3/2018 AVENUE FARRIS, JOEL CHHA 10/30/1971 212 UNION AVENUE NEPTUNE NJ 07753 SUSPENSION 9/20/2001 FARRO, ANDREW 2/3/1961 87 CASTLE RIDGE DRIVE EAST HANOVER NJ 07936 SUSPENSION 6/12/2008 FASANO, JUDITH RN 1/25/1961 1770 YORKTOWNE TOMS RIVER NJ 08753 DISQUALIFICATION 6/5/2017 BOULEVARD FASWALA, MUNIR H. MD 3/20/1957 506 LAGOON BOULEVARD BRIGANTINE NJ 08203 DEBARMENT 9/15/2008 FASWALA, MUNIR H. MD 3/20/1957 506 LAGOON BOULEVARD BRIGANTINE NJ 08203 SUSPENSION 6/26/2005 FATATO, VIRGINIA A. DC 7/3/1960 1437432960 8 N. WHITEHORSE PIKE HAMMONTON NJ 08009 SUSPENSION 5/5/2003 FAULX, LORI RN 8/4/1966 4444 N 7TH AVENUE, APT. PHOENIX AZ 85013 DISQUALIFICATION 11/20/2015 417 FAUSTINO, ALAN MD 4/18/1967 1669482568 110 WEST CHURCH STREET ABSECON NJ 08201 SUSPENSION 8/29/2016 3/8/2019 FAUSTINO, ALAN MD 4/18/1967 1669482568 830 PLYMOUTH PLACE, UNIT OCEAN CITY NJ 08226 DISQUALIFICATION 10/3/2019 2 FAUSTINO, ALAN MD 4/18/1967 1669482568 28 W. GILMAR CIRCLE MARGATE CITY NJ 08402 DISQUALIFICATION 3/8/2019 PERMANENT FEE, CATHERINE ANN RPH 5/9/1965 7353 CLUBHOUSE CIRCLE EGG HARBOR CITY NJ 08215 SUSPENSION 10/19/2006

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE FEINBERG, IRA 411 CHELSEA STREET PARAMUS NJ 07652 DISQUALIFICATION 6/1/1993 FEINMAN, BRIAN DPM 4/29/1963 418 WALNUT STREET NEWARK NJ 07105 SUSPENSION 12/20/2006 FEIT, FREDRIC MD 5/29/1949 1093835308 2 TWIN LAKES DRIVE MANALAPAN NJ 07726 DEBARMENT 7/13/2009 FELDMAN, BRUCE J. 12/12/1948 807 NORTHWINDS DRIVE BRYN MAWR PA 19010 SUSPENSION 3/18/2004 FELDMON, DORON MD 5/25/1960 1194704627 FCI MCKEAN, PO BOX 8000 BRADFORD PA 16701 DISQUALIFICATION 12/29/2015

FELDNER, EDWARD S. MD 11/13/1955 50 E MAIN STREET LITTLE FALLS NJ 07424 DEBARMENT 11/16/1999 DECEASED FELIX, JESSICA CHHA 4/7/1986 40 PASSAIC STREET, APT. 4D HACKENSACK NJ 07601 DISQUALIFICATION 8/14/2015

FELLUS, JONATHAN L. MD 6/9/1966 1053309195 57 WOODLAND AVENUE GLEN RIDGE NJ 07028 DISQUALIFICATION 8/20/2015 5/21/2020 FELSENBERG, SANFORD 517 SO ORANGE AVENUE NEWARK NJ 07103 DISQUALIFICATION 6/1/1993 FERMIN, ESPERANZA CHHA 12/18/1981 229 MADISON AVENUE, APT. PATERSON NJ 07524 DISQUALIFICATION 2/8/2017 1 FERNANDEZ, LUIS DPM 12/7/1965 293 MONROE STREET PASSAIC NJ 07055 SUSPENSION 3/26/1997 FERRANDINO, LUIGI MD 5/5/1923 8 EAST RAMAPO AVENUE MAHWAH NJ 07430 DISQUALIFICATION 5/20/2007 DECEASED FERRARI, FRANCIS M. DPM 3/10/1947 482 KEARNEY AVENUE KEARNY NJ 07032 DISQUALIFICATION 2/16/1995 FERRINGO, MICHAEL J. 9/5/1979 616 GLEN COURT TURNERSVILLE NJ 08012 DISQUALIFICATION 6/20/2012 FERSTANDIG, RUSSELL A. MD 5/17/1949 1780779702 179 MAPLE AVENUE RIDGEWOOD NJ 07450 DISQUALIFICATION 12/7/1987 1/1/2013 FIELDS, CARENE CHHA 9/27/1970 190 HAMILTON AVENUE, PATERSON NJ 07501 DISQUALIFICATION 2/20/2017 APT. #8 FIGUEROA, DESIREE CHHA 10/10/1992 11 COLLETON STREET LAKEWOOD NJ 08701 DISQUALIFICATION 2/20/2017 FIGUEROA, JORGE MD 7/15/1958 1770542151 493 21ST AVENUE PATERSON NJ 07513 DEBARMENT 1/23/2018 FIGUEROA, JORGE MD 7/15/1958 1770542151 USP-LEWISBURG, PO BOX LEWISBURG PA 17837 DISQUALIFICATION 4/19/2018 1000 FILIPPONE JR., DENNIS R. MD 11/18/1957 147 STANTON ROAD FLEMINGTON NJ 08822 DEBARMENT 11/21/1998 FINDER, RICHARD DC 6/12/1956 810 ABBOTT BOULEVARD FORT LEE NJ 07024 DEBARMENT 5/1/2004 FINE, EDWARD MD 10/24/1933 271 MOORE LANE HADDONFIELD NJ 08033 DISQUALIFICATION 9/28/1983 FINESMITH, ROSS MD 3/27/1961 PARKVIEW AVENUE BASKING RIDGE NJ 07920 DISQUALIFICATION 8/10/2007 FINE-TRANS MEDICAL 2824 KENNEDY BOULEVARD JERSEY CITY NJ 07306 DISQUALIFICATION 6/14/1994 TRANS. #465 FINK, DAVID PSYCH 2/26/1928 139 HIGHLAND AVENUE METUCHEN NJ 08840 SUSPENSION 5/20/2003 FINKEL, MARINA 4/30/1963 75 STONEGATE DRIVE STATEN ISLAND NY 10304 DISQUALIFICATION 10/3/2013

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE FINKEL, MARINA 4/30/1963 EDNA MAHAN CLINTON NJ 08809 DISQUALIFICATION 6/15/2014 CORRECTIONAL FINLAY MEDICAL 4912 BERGENLINE AVENUE WEST NEW YORK NJ 07093 DISQUALIFICATION 3/14/1998 LABORATORY FIRESPIRIT, INC. 6612 TERRA DOLCE AVENUE ALBUQUERQUE NM 87114 DISQUALIFICATION 6/23/2011 NW FISCHBERG, JUAN C. MD 10/6/1947 354 RUSSELL AVENUE EDGEWATER NJ 07020 SUSPENSION 6/19/2008 FISCHGRUND, JOEL MD 3/3/1953 1427097534 56 CORNELL DRIVE LIVINGSTON NJ 07039 DEBARMENT 8/30/2014 FISCHGRUND, JOEL MD 3/3/1953 1427097534 56 CORNELL DRIVE LIVINGSTON NJ 07039 DISQUALIFICATION 3/24/2017 FISCHMAN, HAROLD MD 6/3/1903 56 BOWDOIN STREET MAPLEWOOD NJ 07040 DISQUALIFICATION 6/1/1993 FISH, MICHAEL DMD 10/19/1977 1500 PINE PARK AVENUE LAKEWOOD NJ 08701 DEBARMENT 4/20/2007 7/17/2013 FISHER, CALLETTA PHARM 5/16/1996 115 SENECA BOULEVARD BARNEGAT NJ 08005 DISQUALIFICATION 11/21/2016 TECH FISHER, DARRYL 4/12/1968 55 SHELBOURNE STREET BURLINGTON NJ 08016 DISQUALIFICATION 3/6/2006 FLEISCHER, MARK H. MD 7/7/1948 PO BOX 600, FCI OTISVILLE OTISVILLE NY 10963 SUSPENSION 4/20/2005 FLEISCHMAN, EDWARD DO 10/3/1928 3804 CHURCH ROAD MOUNT HOLLY NJ 08054 SUSPENSION 8/25/1998 FLEMING, KEVIN M. MD 6/30/1954 1508816075 710 STATION AVENUE, 2ND HADDON HEIGHTS NJ 08035 SUSPENSION 11/20/2010 FLR FLEURANTIN, MARIE RN 9/3/1958 14 OAK TREE COURT WESTAMPTON NJ 08060 DISQUALIFICATION 10/24/2018 FLEURANTIN, RUBEN J. MD 11/20/1951 SCOTLAND ROAD SO. ORANGE NJ 07079 SUSPENSION 3/20/2008 FLEURY, DIANE RN 2/22/1951 552 PENNY STREET FRANKLINVILLE NJ 08322 SUSPENSION 5/20/2001 FLORES, CARMEN CHHA 10/25/1975 95 PROSPECT STREET, APT. PASSAIC NJ 07055 DISQUALIFICATION 3/6/2018 #1 FLORES, MARIE MIRAVITE RN 2/15/1957 258 DEEP BROOK COURT PISCATAWAY NJ 08854 DEBARMENT 9/20/2004 FLORES, MELBA CHHA 11/17/1969 106 MAPLE AVENUE BOONTON NJ 07005 DISQUALIFICATION 2/20/2017 FLOUNDERS, JOSEPH P. LPN 11/3/1968 106 W. MIAMI AVENUE VILLAS NJ 08251 SUSPENSION 10/20/2005 FLOWERS JR., HERMAN J. CHHA 10/30/1964 143 URSINUS COURT PEMBERTON NJ 08075 DISQUALIFICATION 12/10/1997 FLOWERS, FELICIA CHHA 7/11/1977 321 NEPTUNE BOULEVARD NEPTUNE NJ 07753 DISQUALIFICATION 7/14/2017 FLOWERS, HERMAN T. 143 URSINUS COURT PEMBERTON NJ 08075 SUSPENSION 3/16/1999 FLOYD, JAMES 7/11/1963 1733 BLAKE BOTTOM ROAD HUNTSVILLE AL 35806 DISQUALIFICATION 2/26/2010 NW FOGLER, SEAN MD 10/8/1968 1548322068 1900 HAMILTON STREET PHILADELPHIA PA 19130 DISQUALIFICATION 8/28/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE FOGLER, SEAN MD 10/8/1968 1548322068 201 N. 8TH STREET, UNIT 911 PHILADELPHIA PA 17105- DISQUALIFICATION 5/20/2019 2675 FOLK, THOMASA A. 2/3/1960 463 IRVINGTON AVENUE ELIZABETH NJ 07201 DISQUALIFICATION 3/19/2006 FOLKERTS, ANNAMARIA MD 8/24/1961 32 OAK PLACE HAWTHORNE NJ 07506 DISQUALIFICATION 12/8/1993 FONTANELLA, DANIEL DC 10/16/1964 27 MOUNTAINWOOD COURT TOTOWA NJ 07512 SUSPENSION 11/20/2003

FONTANEZ, MODESTO MD 1/4/1948 1851395826 1838 2ND AVENUE NEW YORK NY 10128 DISQUALIFICATION 10/7/2011 FORBES, AASE RN 4/5/1967 882 DEWEY STREET UNION NJ 07083 DISQUALIFICATION 4/20/2009 FORD, MARYKATE RN 4/23/1985 103 SWEETWATER DRIVE CINNAMINSON NJ 08077 DISQUALIFICATION 7/30/2018 FORD, TAMIKA CHHA 600 ELM STREET CAMDEN NJ 08102 DISQUALIFICATION 1/31/2017 FORDE, SHIVONNE 11/24/1982 57 CHESTNUT STREET C4 EAST ORANGE NJ 07018 DISQUALIFICATION 3/8/2010 3/8/2015 FORMAN, STEVE DPM 5/10/1957 1700850096 15 CANTERBURY PLACE SICKLERVILLE NJ 08081 DEBARMENT 4/18/2017 FORNEY, DONALD 6/20/1967 354 CRESCENT STREET HARRISBURG PA 17104 DISQUALIFICATION 11/20/2015 FORSHAY, LAUREN RN 1/12/1977 2201 RIVER ROAD PT. PLEASANT BORO NJ 08742 DISQUALIFICATION 10/25/2016 6/26/2017 FORTI, PAUL J. PSYCH 6/24/1949 6 SILVER SPRING COURT EAST HANOVER NJ 07936 DISQUALIFICATION 7/19/2001 FORTUNATO, FRANKLIN MD 12/31/1949 1548278930 FMC - DEVENS, PO BOX 879 AYER MA 01432 DISQUALIFICATION 2/11/2016

FORTUNATO, FRANKLIN MD 12/31/1949 1548278930 127 PINE STREET MONTCLAIR NJ 07042 DISQUALIFICATION 6/29/2015 FOSTER, DEBRA CHHA 1/11/1995 714 ZLOTKIN CIRCLE, APT. 6 FREEHOLD NJ 07728 DISQUALIFICATION 4/18/2017

FOWLER, BERNARD J. MD 3/24/1945 1326105032 15 GRIST MILL RUN MAHWAH NJ 07430 DISQUALIFICATION 3/27/2014 FOWLER, BERNARD J. MD 3/24/1945 1326105032 1341 MIDDLE GULF DRIVE SANIBEL FL 33957 DISQUALIFICATION 8/20/2015 12D FOX, SUSAN DMD 12/28/1979 1952661472 2300 WALNUT STREET PHILADELPHIA PA 19103 DISQUALIFICATION 12/29/2015 FRAENKEL, DAVID M. DDS 12/7/1957 1790774271 BERGEN MALL DENTAL PARAMUS NJ 07652 DISQUALIFICATION 11/4/1991 4/5/2018 OFFICE FRANCILLON. CARLINE LPN 7/23/1985 98 ASHLAND AVENUE, 2ND WEST ORANGE NJ 07052 DEBARMENT 11/13/2017 FLOOR FRANCO, DAISY CHHA 9/5/1973 URB JARDIN DE S. ANNA COAMO PR 00769 DISQUALIFICATION 8/10/2007 FRANCOIS, EMMANUEL MD 5/4/1954 1457383382 187 HOBART GAP ROAD LIVINGSTON NJ 07039 DISQUALIFICATION 10/10/2016 7/19/2019 FRANCOIS, ESTHER CHHA 9/21/1986 514 LIDGERWOOD AVENUE ELIZABETH NJ 07202 DISQUALIFICATION 1/17/2018 FRANK, OLEG MD 1/22/1971 1457469090 40 FERRY STREET NEWARK NJ 07105 DEBARMENT 9/9/2016 2/7/2020

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE FRANKLIN MEDICAL 14 FRANKLIN STREET BELLEVILLE NJ DISQUALIFICATION 10/15/1999 ASSOCIATES FRARE, ROBERT DMD 9/16/1964 1740477553 15 PROMENADE PLACE VOORHEES NJ 08043 DISQUALIFICATION 8/29/2014 FRASCA, CLIFFORD C. 5/22/1961 637 WESTON DRIVE TOMS RIVER NJ 08755 SUSPENSION 4/8/1999 FRASER, KEITH MD 7/25/1957 1881621266 6 WEDGEWOOD DRIVE, UNIT VERONA NJ 07044 DISQUALIFICATION 1/10/2011 12/4/2014 7 FRASER, SHAWN E. 1/1/1969 PO BOX 7000 FORT DIX NJ 08640 SUSPENSION 10/20/2005 FREDERICK, KIMBERLY M. RN 8/21/1966 78 BOUNDARY AVENUE HANOVER PA 17331 DEBARMENT 9/12/2008 FREE, KEVIN R. MD 12/13/1955 14 PATTEN TERRACE CEDAR GROVE NJ 07009 DISQUALIFICATION 7/14/1998 DECEASED FREILER, JOHN DMD 8/14/1938 1295815710 2307 WARRENS WAY WANAQUE NJ 07465 DISQUALIFICATION 12/26/2018 FREMPONG, EBENEZER CHHA 8/12/1969 30 POST STREET, APT. 6M YONKERS NY 10705 DEBARMENT 7/2/2018 FRENCH, EUGENE MD 10/22/1959 1215927843 241 SUMMIT AVENUE HACKENSACK NJ 07601 DEBARMENT 4/18/2016 FRICK, JAEMS 10/17/1959 1626 ABBOT AVENUE TOMS RIVER NJ 08753 DISQUALIFICATION 5/5/2004 FRIDMAN, LEV CHHA 7/12/1941 6 SALT MEADOW ROAD EAST BRUNSWICK NJ 08816 DEBARMENT 5/2/2017 FRIED, MARTIN MD 1/23/1958 1407087802 5 SHINNECOCK HILLS DRIVE ASBURY PARK NJ 07712 DEBARMENT 10/21/2019

FRIED, MARTIN MD 1/23/1958 1407087802 5 SHINNECOCK HILLS DRIVE ASBURY PARK NJ 07712 DISQUALIFICATION 9/17/2018

FRIEDMAN, AMIR MD 6/30/1968 1417907361 390 N. BROADWAY, STE 1000 PENNSVILLE NJ 08070 DEBARMENT 8/1/2014 8/11/2016

FRIEDMAN, LAWRENCE A. 10/1/1947 1688-90 54TH STREET BROOKLYN NY 11024 DISQUALIFICATION 6/16/2002 FRIEDMAN, SHERRY RN 1/11/1968 12 HOPI TRAIL OAK RIDGE NJ 07348 SUSPENSION 9/19/2003 FRIEND, CHARLES LPN 6/18/1955 2336 CORBETT ROAD PENNSAUKEN NJ 08109 SUSPENSION 6/19/2003 FRIMPONG, JOSEPH CHHA 3/2/1948 357-363 LINCOLN AVENUE, ORANGE NJ 07050 DISQUALIFICATION 1/31/2017 APT. 3D FRIMPONG, KOFI LPN/RN 7/23/1951 ESSEX ROAD MAPLEWOOD NJ 07040 DEBARMENT 12/20/2007 FRISCH, FREDERICK MD 5/10/1917 7 SOUTH DUDLEY AVENUE VENTNOR NJ 08406 DISQUALIFICATION 3/5/1994 DECEASED FRITTS, LARRY F. RN 5/15/1965 5 AUTUMN RIDGE LANE PHILLIPSBURG NJ 08865 SUSPENSION 6/20/2005 FRITZ, GINA LPN 2/24/1963 52718-2 PIMA COURT KILEEN TX 76543 DISQUALIFICATION 5/14/2018 FROHWIRTH, DANIEL H. MD 6/6/1947 MEADOW ROAD, PO BOX WHITEHOUSE NJ 08888 DISQUALIFICATION 4/18/1992 274 FROMER, CARL H. MD 4/25/1950 1000 CLOVER ROAD, APT. 7R STATEN ISLAND NY 10314 DISQUALIFICATION 6/20/2000

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE FROMM, JOSEPH 10/29/1947 28301 ATLANTIC AVENUE ATLANTIC CITY NJ 08401 DISQUALIFICATION 3/17/1991 MICHAEL #110 S FROSCH, LISA AKA LISA RN 4/15/1976 111 BEECHWOOD AVENUE OAKLYN NJ 08107 SUSPENSION 10/18/2001 PLOTTS FRYE, ROBIN CHHA 7/19/1963 1224 WASHINGTON AVENUE CAMDEN NJ 08104 DISQUALIFICATION 2/13/2018 PERMANENT

FRYER, CYNTHIA LPN 12/8/1967 PO BOX 121 MERRY HILL NC 27957 DISQUALIFICATION 12/29/2017 FUNICELLO, KELLY M. AKA LPN 12/27/1971 SANDYBROOK ROAD MANALAPAN NJ 07726 SUSPENSION 8/20/2008 MCLAUGHLIN, KELLY

FURLONG, KELLY AKA PHARM 3/21/1985 52 CORNELL DRIVE HAZLET NJ 07730 DISQUALIFICATION 9/23/2016 COPPOLA, KELLY TECH GABER, ROBERT A. DDS 11/13/1947 100 VAIL ROAD PARSIPPANY NJ 07054 DISQUALIFICATION 12/19/1988 GABRIEL, NWALA RPH 7/7/1960 34 SCHOOL STREET PISCATAWAY NJ 08854 DISQUALIFICATION 2/23/2010 GADHOK, RAJINDER S. 8/9/1937 120 CIRCEL AVENUE, BOX BERKELEY HEIGHTS NJ 07922 DISQUALIFICATION 8/12/1997 121 GAFFNEY, JOHN DO 4/7/1962 1710985387 9501 VENTNOR AVENUE MARGATE CITY NJ 08402 DISQUALIFICATION 7/24/2017 GAINER, JAHNIA PHARM 11/29/1992 176 AVON AVENUE. APT. 4A NEWARK NJ 07108 DEBARMENT 4/26/2016 TECH GAINES, TONI 8/3/1974 4650 COLES MILL ROAD R-3 WILLIAMSTOWN NJ 08094 DISQUALIFICATION 8/4/2012 8/3/2014

GAITHER, HERBERT MD 11/21/1936 1453 HILLCREST COURT, APT. CAMP HILL PA 17011 DISQUALIFICATION 11/20/2015 407 GALCIK, DIANE LPN 8/9/1955 34 MAHAN STREET TENAFLY NJ 07670 SUSPENSION 8/20/2001 GALIN, MILES A. MD 1/6/1932 EAST END AVENUE NEW YORK NY 10128 DEBARMENT 9/19/2008 GALINSKY, KIMBERLY RPH 5/23/1989 220 VAN FLEET AVENUE SOUTH PLAINFIELD NJ 07080 DISQUALIFICATION 8/10/2017 GALINSKY, RONALD C. PSYCH 8/13/1941 34 DUNHILL DRIVE VOORHEES NJ 08043 DISQUALIFICATION 12/1/1998 GALL, WILLIAM J. DO 4/4/1943 22 STONEGATE COURT BLACKWOOD NJ 08012 DISQUALIFICATION 7/20/2009 GALLAGHER JR., WALTER RN 9/19/1950 132 TULIP LANE SUMMIT NJ 07901 SUSPENSION 9/20/2005 B. GALLAGHER, BRENDA JO RN/LPN 5/4/1955 14B WISHING WELL ROAD HAMBURG NJ 07419 SUSPENSION 4/19/2001 GALLAGHER, JOANNE M. DC 9/23/1959 108 BENJAMIN AVENUE CONYNGHAM PA 18219 SUSPENSION 10/20/2005 GALLAGHER, PATRICIA A. RN 4/3/1986 111 QUAKER ROAD MICKLETON NJ 08056 DISQUALIFICATION 8/20/2014

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GALLE, JAMES RPH 5/8/1946 105 ELM AVENUE HACKENSACK NJ 07644 DISQUALIFICATION 9/16/2003 GALLETTA, ERNEST 3/16/1949 FCI FAIRTON, PO BOX 420 FAIRTON NJ 08320 SUSPENSION 2/19/2009 GALLETTA, GEORGE W. 4/13/1952 3001 E. CHESTNUT AVENUE VINELAND NJ 08361 DISQUALIFICATION 2/19/2009 A1 GAMAO, EDDIE MD 6/2/1940 1639479397 375 NORTH DRIVE J9 NORTH PLAINFIELD NJ 07060 DISQUALIFICATION 3/14/2018 GAMAO, EDDIE MD 6/2/1940 1639479397 375 NORTH DRIVE J9 NORTH PLAINFIELD NJ 07060 DISQUALIFICATION 10/31/2018 PERMANENT GAMUZZA, VINCENT OPTOME 9/11/1986 1063851285 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 11/20/2018 TRIST GANDHI, HIREN 2/15/1962 120 ROLLING BROOK DRIVE EDISON NJ 08820 SUSPENSION 10/20/2005

GANETSKY, SVETLANA PT 5/25/1977 1407180037 197 EDWARDS DRIVE SOUTHAMPTON PA 18966 DISQUALIFICATION 11/20/2015 GANTI, SHASHI MD 3/15/1954 1023037215 2035 HAMBURG PIKE WAYNE NJ 07410 DISQUALIFICATION 8/20/1997 3/3/2020 GARCEN, GINA AKA DC 4/14/1962 57 GREEN STREET WOODBRIDGE NJ 07095 DISQUALIFICATION 3/24/2000 CIALLELLA, GINA GARCIA, DIANE LCSW 12/3/1947 6612 TERRA DOLCE AVENUE ALBUQUERQUE NM 87114 DISQUALIFICATION 1/18/2012 NW GARCIA, SHEILA CHHA 3/2/1995 1003 W. CHAPLAIN ROAD MANVILLE NJ 08836 DISQUALIFICATION 5/2/2017 GARDINER, MICHAEL, A. DC 12/27/1952 1346524907 2066 MILBURN AVENUE MAPLEWOOD NJ 07040 SUSPENSION 2/3/2003 GARIPALLI, LAXMIPATHI MD 10/22/1949 1851325500 11 COLTS GAIT LANE COLTS NECK NJ 07722 SUSPENSION 4/21/2008 GARIPALLI, LAXMIPATHI MD 10/22/1949 1851325500 11 COLTS GAIT LANE COLTS NECK NJ 07722 DISQUALIFICATION 9/20/2012 GARRETSON, MATTHEW PHARM 3/10/1990 119 GLEN AVENUE LAKEWOOD NJ 08701 DISQUALIFICATION 9/23/2016 GARRITANO, RALPH E. MD 9/12/1924 281 GROVE STREET ORADELL NJ 07649 DISQUALIFICATION 6/1/1993 GAULT, TYMIER CHHA 4/12/1990 180 HAYNES AVENUE BRIDGETON NJ 08302 DEBARMENT 7/22/2017 GAYLE, DELORES MD 10/11/1940 1508886664 249 GREGORY AVENUE WEST ORANGE NJ 07052 DEBARMENT 12/16/2015 6/5/2017 GAYLE, DELORES MD 10/11/1940 1508886664 249 GREGORY AVENUE WEST ORANGE NJ 07052 DISQUALIFICATION 6/5/2017 PERMANENT GAYLE, LURINE CHHA 2/15/1961 2144 ALDRIN ROAD, #5A OCEAN NJ 07712 DISQUALIFICATION 2/8/2017 GECYS, GINTARE T. DO 3/15/1961 1504 BLACKWOOD BLACKWOOD NJ 08012 DEBARMENT 9/22/2015 5/21/2020 CLEMENTON GEFFEN, STEVEN 1/27/1957 50 SKYLARK COURT MARLBORO NJ 07746 DISQUALIFICATION 8/15/2000 GENNINGER, LEWIS E. MD 1/26/1916 95 SOUTH MAIN STREET PHILLIPSBURG NJ 08865 DISQUALIFICATION 1/10/1988 DECEASED GENSHEIMER, MAUREEN LPN 3/1/1957 1409 EDGEMERE ROAD WALL NJ 07719 SUSPENSION 9/19/2002

GEORGE, JOBY RPH 5/14/1974 1255481917 395 MYRTLE STREET CLIFFWOOD NJ 07721 DEBARMENT 7/18/2011

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GEORGIA LUNG 1104989136 3820 MEDICAL PARK AVENUE AUSTELL GA 30106 DISQUALIFICATION 11/20/2015 ASSOCIATES GERARDO, LETRICIA M. MD 6/4/1934 317 MOUNT PROSPECT NEWARK NJ 07104 DISQUALIFICATION 5/30/1997 AVENUE GERMAN, MARIA CHHA 6/17/1967 195 BROADWAY PATERSON NJ 07505 DEBARMENT 5/24/2002 GETSON, LEE 6/1/1952 7 HAMILTON COURT SOUTHAMPTON NJ 08088 DISQUALIFICATION 5/12/2016 GIACALONE-HEWSON, DC 9/14/1971 1487782504 FCI COLEMAN MEDIUM, PO COLEMAN FL 33521 DISQUALIFICATION 11/20/2015 MARIA BOX 1032 GIALANELLA, CRAIG MD 10/28/1963 1467596502 4 OXFORD ROAD NORTH CALDWELL NJ 07006 DISQUALIFICATION 7/19/2017 GIAMPORCARO, STEVEN MD 9/26/1954 1255356994 15 GLEN AIRE DRIVE EGG HARBOR NJ 08234 DISQUALIFICATION 2/22/2019 PERMANENT TOWNSHIP GIANETTI JR., JOSEPH P. DC 12/21/1956 LINDEMAN AVENUE CLOSTER NJ 07624 SUSPENSION 9/18/2008 GIANNOTTO, ANTHONY MD 12/26/1919 31 PALM STREET NEWARK NJ 07106 DISQUALIFICATION 11/24/1988 GIARRETTA, MARY RPH 1/19/1951 9 KINGWOOD AVENUE FRENCHTOWN NJ 08825 DISQUALIFICATION 2/15/2001 SUEANNE GIBBONS, SHANIKA CHHA 12/29/1986 11 LINDEN AVENUE EDISON NJ 08817 DISQUALIFICATION 1/31/2017 GIBBONS, SHAWN S. 2/7/1972 40 DOVER STREET NEWARK NJ 07106 DEBARMENT 11/24/2007 GIBBONS, WAYNE L. MD 12/10/1948 2 EAST RIVER DRIVE WILLINGBORO NJ 08046 DEBARMENT 1/12/2001 GIBBS, ARLENE CHHA 1/21/1976 35 CIVIC SQUARE, #23 IRVINGTON NJ 07111 DISQUALIFICATION 1/28/2006 GIBBS, ARLENE CHHA 1/21/1976 18 BELLEVILLE COURT, APT C BELLEVILLE NJ 07109 DEBARMENT 5/20/2007

GIBBS, MARY ELLEN CHHA 4/22/1971 157 ANDREW STREET HAMILTON NJ 08610 SUSPENSION 2/14/2002 GIBNEY, EDWARD 10 CEDAR LAKE DENVILLE NJ 07834 DISQUALIFICATION 6/1/1993 GIBSON, MARY E. 1/20/1964 376 MADISON AVENUE RAHWAY NJ 07065 DISQUALIFICATION 7/18/2001 GIFFINS-MATLACK, LPN 4/3/1985 46 BURT STREET BRIDGETON NJ 08302 DISQUALIFICATION 8/28/2017 DEANNE GILL, ALYSON R. RN 8/8/1964 115 BRADLEY COURT LAUREL SPRINGS NJ 08021 SUSPENSION 6/19/2003 GILL, JEFFREY J. DPM 3/30/1954 1168 BEACON AVENUE MANAHAWKIN NJ 08050 DEBARMENT 9/13/1999 GILL, YURI CHHA 12/10/1984 13 PINE GLEN DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 9/19/2017 GILLARD, MARY RN 8/18/1969 321 SUNSET AVENUE, APT. ASBURY PARK NJ 07712 SUSPENSION 4/20/2003 2H GILLER, LEONID 9/4/1949 4 WOODFERN STREET EDISON NJ 08820 DEBARMENT 8/27/1999 GILLIARD, MICHELLE CHHA 4/18/1978 2929 HURLEY POND ROAD WALL NJ 07719 DEBARMENT 1/20/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GILLISS, ADAM DO 1/31/1966 1982741328 27 EAST CHESTNUT AVENUE MERCHANTVILLE NJ 08109 DEBARMENT 12/16/2015

GILMAN, DANIEL 1/14/1953 FCI - FAIRTON, PO BOX 420 FAIRTON NJ 08320 DISQUALIFICATION 7/20/2017 GILMAN, DENISE DO 2/28/1977 1689986960 108 WOODCREST DRIVE CORAOPOLIS PA 15108 DISQUALIFICATION 11/20/2015 9/19/2016 GILMORE, BRUCE MD 10/23/1955 1306985882 FRANKLIN DRIVE ARDMORE OK 73401 SUSPENSION 9/18/2008 STEWART GILTMAN, JEROME RPH 4/18/1934 7320 VENTOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION 4/30/2007 GIRARDY, MATTHEW DDS 3/14/1970 1831278118 1285 BRADFORD RUN SPRING LAKE NJ 07762 DISQUALIFICATION 5/20/2019 GITKIN, SAMUEL 9/1/1947 1288 15TH STREET FORT LEE NJ 07024 SUSPENSION 4/18/2002 GLASER, VICTORIA M. RN 10/7/1962 1612 THIRD STREET RENSSELAER NY 12144 SUSPENSION 7/18/2002 GLASS, JOEL MD 12/23/1942 1861537219 2027 SPRING GARDEN PHILADELPHIA PA 19130 DISQUALIFICATION 6/28/2017 PERMANENT STREET GLASS, JOEL MD 12/23/1942 1861537219 2027 SPRING GARDEN PHILADELPHIA PA 19130 DISQUALIFICATION 10/27/2017 PERMANENT STREET GLASS, MICHAEL R. PSYCH 7/3/1933 1345 SLATERVILLE ROAD ITHACA NY 14850 DEBARMENT 1/18/2007 GODBOLT, KIMISHA CHHA 1/4/1983 190 HAMILTON AVENUE PATERSON NJ 07501 DEBARMENT 8/24/2017 GODWIN, LASTAISA PHARM 6/15/1993 6 HILLSIDE TERRACE SUSSEX NJ 07461 DISQUALIFICATION 2/1/2018 TECH GOLDBERG, CHARLES S. MD 10/3/1953 1164443958 FCI-OTISVILLE, PO BOX 1000 OTISVILLE NY 10963 DISQUALIFICATION 1/22/2016

GOLDBERG, RICHARD MD 2/6/1950 1629136320 FEDERAL BUREAU PRISONS - BROOKLYN NY 11232 DISQUALIFICATION 2/9/2017 RRM #66231-050 100 29TH STREET GOLDBERG, RICHARD MD 2/6/1950 1629136320 95 DAVIS HILL ROAD WESTPORT CT 06883 DEBARMENT 7/1/2015 GOLDIS, MICHAEL MD 12/28/1956 1982603247 36 STOKES ROAD MOUNT LAUREL NJ 08054 DISQUALIFICATION 10/30/2020 GOLDSTEIN, JACK DO 3/28/1937 1154355055 695A MAIN STREET LUMBERTON NJ 08048 DEBARMENT 8/28/2014 DECEASED GOLDSTEIN, JACK DO 3/28/1937 1154355055 695A MAIN STREET LUMBERTON NJ 08048 DISQUALIFICATION 11/20/2015 DECEASED GOLDSTEIN, JEFFREY DO 12/29/1969 1831158088 90 BARNARD ROAD NEW ROCHELLE NY 10801 DISQUALIFICATION 4/14/2021 PERMANENT GOLDTHWAITE, JENNIFER LPN 3/9/1979 507 KENBURY ROAD BRANCHBURG NJ 08876 DISQUALIFICATION 3/15/2018

GOLEJ, IVY RN 11/5/1973 631 MARION ROAD NEPTUNE NJ 07753 DISQUALIFICATION 9/9/2016 GOLIN, MARK W. MD 11/20/1941 172 FRANKLIN AVENUE, RIDGEWOOD NJ 07450 SUSPENSION 3/20/2003 SUITE 4

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GOMEZ, ALFREDO CHHA 12/23/1965 148 NORTH 10TH STREET, PATERSON NJ 07522 DISQUALIFICATION 4/26/2018 2ND FLOOR GOMOLINSKI, NANCY LCSW 1/1/1953 1700986890 23 FORSHEE CIRCLE MONTVALE NJ 07645 DISQUALIFICATION 5/7/2014 GONSHERY, DENISE C. RPH 10/19/1963 900 MCELWEE ROAD MOORESTOWN NJ 08057 SUSPENSION 2/20/2005 GONZALEZ, ARELIS CHHA 11/1/1985 28 MADOLE PLACE PENNS GROVE NJ 08069 DISQUALIFICATION 1/31/2017 GONZALEZ, FELICIA E. DO 9/11/1958 1598850935 1203 GREEN VIEW WAY TOMS RIVER NJ 08753 DEBARMENT 9/19/2011 6/17/2013 GONZALEZ, JORDAN RPH 2/14/1980 1992073167 #66214-050, FCI FAIRTON, FAIRTON NJ 08320 DISQUALIFICATION 2/9/2017 PO BOX 420 GONZALEZ, LEAH CHHA 3/27/1993 5 TWIN RIVERS DRIVE EAST WINDSOR NJ 08520 DEBARMENT 1/16/2017 5/6/2021 GONZOPH, BARBARA AKA LPN 3/29/1964 208 WAYNE TERRACE COLLINGSWOOD NJ 08108 SUSPENSION 8/19/2004 DUFFY, BARBARA GOOBERMAN, LANCE MD 12/8/1944 1194998682 1 SOUTH CENTRE STREET MERCHANTVILLE NJ 08109 SUSPENSION 2/24/2004 7/23/2012 GOODEY, KATHLEEN 7/13/1961 333 WHITTIER AVENUE DUNELLEN NJ 08812 SUSPENSION 5/23/1997 GOODIN, RICHARD C. MD 8/13/1943 RIVERVIEW CORRECTIONAL OGDENSBURG NY 13669 SUSPENSION 8/19/2004

GOODNIGHT, JAMES W. MD 12/11/1962 1144313131 535 HIGH MOUNTAIN ROAD NORTH HALEDON NJ 07508 DEBARMENT 1/17/2014 4/11/2017

GOODWIN, BARBARA G. RN 2/23/1959 1201 NORTH CHARLOTTE DICKSON TN 37055 SUSPENSION 12/19/2002 STREET GORCEY, STEVEN MD 4/18/1960 1679512941 32 VALLEY FORGE ROAD EATONTOWN NJ 07724 DISQUALIFICATION 6/11/2019 1/7/2021 GORDON, BARBARA X-RAY 8/23/1963 133 MORTON AVENUE SOUTH PLAINFIELD NJ 07080 DISQUALIFICATION 4/5/2001 GORDON, CRAIG W. MD 9/27/1957 164 RIVEREDGE DRIVE CHATHAM NJ 07928 DISQUALIFICATION 9/4/2007 GORDON, CRAIG W. MD 9/27/1957 8 SHERWOOD CIRCLE LINDEN NJ 07036 DISQUALIFICATION 3/18/1993 GORDON, HOWARD L. MD 2/15/1926 222 BROADWAY NEWARK NJ 07104 DISQUALIFICATION 6/1/1993 GORDON, RAHSHEEDA CHHA 3/3/1979 445 SOUTH 11TH STREET NEWARK NJ 07103 DISQUALIFICATION 2/8/2017 GORIGANTI, MAHENDER MD 9/19/1959 1144202805 7187 WOODCHUCK HILL FAYETTEVILLE NY 13066 DISQUALIFICATION 7/20/2015 ROAD GOROVITS, LILIA MD 4/20/1958 1427163427 1157 METTLER ROAD HUNTINGTON VALLEY PA 19006 DISQUALIFICATION 8/7/2017

GORUKANTI, SURENDER MD 1/19/1968 1750488292 4324 BEDFORD AVENUE BROOKLYN NY 11229 DISQUALIFICATION 8/20/2018 GORUKANTI, SURENDER MD 1/19/1968 1750488292 4324 BEDFORD AVENUE BROOKLYN NY 11229 DISQUALIFICATION 1/31/2019 PERMANENT GOTAY, ALEXANDER LCSW 8/26/1961 SSCF, PO BOX 150 DELMONT NJ 08314 DISQUALIFICATION 2/24/2008

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GOULBOURNE, MARIANA CHHA 6/19/1964 430 S. 13TH STREET NEWARK NJ 07103 DISQUALIFICATION 3/6/2018

GRANGER, MAI AKA CHHA 9/21/1958 15 PEPPERMINT LANE WILLINGBORO NJ 08046 DISQUALIFICATION 9/29/1999 GRIFFITHS, MAI GRANT, NICOLE CHHA 11/28/1984 18 BUCKNELL DRIVE TOMS RIVER NJ 08757 DISQUALIFICATION 1/31/2017 GRANVILLE, PEDRO JULIO LAB 1/30/1962 823 BROADWAY WEST LONG BRANCH NJ 07764 DISQUALIFICATION 8/20/2015 TECH. GRASSER, JENNIFER AKA RN 7/6/1963 232 CLUB DRIVE WALL NJ 07719 SUSPENSION 10/20/2002 KROWICKI, JENNIFER GRAUERHOLZ, JOHN E. MD 12/11/1941 PO BOX 2172 LEESBURG VA 22075 SUSPENSION 9/19/2002 GRAY, KEVIN 129 CHANCELLOR AVENUE NEWARK NJ 07112 DISQUALIFICATION 6/1/1993 GRAY-KEARLY, ASHLEE CHHA 10/24/1987 10 CORAL DRIVE HOWELL NJ 07731 DISQUALIFICATION 1/31/2017 GRAYOVSKI, ELIZABETH CHHA 1/29/1986 206 NORTHFIELD ROAD MILLINGTON NJ 07946 DEBARMENT 7/14/2017 GRAYSON, MURRAY A. RPH 6/9/1941 163 HAMPTON GREEN STATEN ISLAND NY 10312 DISQUALIFICATION 6/1/1993 GRAZIANO, NATALE MD 3/25/1926 470 BROOKSIDE LANE SOMERVILLE NJ 08876 DISQUALIFICATION 12/1/1998 DECEASED GREEN, JOHN N. MD 10/5/1953 1114072444 61 MAIN STREET WEST ORANGE NJ 07102 SUSPENSION 2/22/2012 6/21/2012 GREEN, JOHN N. MD 10/5/1953 1114072444 3 PADDOCK COURT BASKING RIDGE NJ 07920 DEBARMENT 9/25/2014 GREEN, JOYCE D. CHHA 8/25/1960 PO BOX 145 WOODBINE NJ 08270 SUSPENSION 8/20/2003 GREEN, ROBERT MD 3/30/1921 22 OLD SHORT HILLS ROAD LIVINGSTON NJ 07039 DISQUALIFICATION 9/2/1992 DECEASED GREENBERG, ANTHONY MD 3/17/1960 1487641239 576 STATE ROUTE 94 COLUMBIA NJ 08732 DISQUALIFICATION 10/29/2016 GREENBERG, EDMUND RPH 7/15/1939 270 HIGHLAND ROAD SOUTH ORANGE NJ 07079 DISQUALIFICATION 2/7/2000 DECEASED GREENBERG, LAUREN LPN 4/12/1985 1376 WEST MAIN STREET MILLVILLE NJ 08332 DISQUALIFICATION 5/25/2019 GREENE, LIZA RN 2/5/1974 57 N. RIVER DRIVE PENNSVILLE NJ 08070 SUSPENSION 9/19/2003 GREENFARB, IRVING DO 9/24/1929 160 LITTLETON ROAD MORRIS PLAINS NJ 07950 DISQUALIFICATION 12/19/1988 DECEASED GREENFIELD, RONALD W. 6/11/1955 227 CLUB DRIVE WALL NJ 07719 SUSPENSION 7/19/2001 GREENLEAF, JANICE LPN 3/25/1954 110 EAST JUNIPER AVENUE NORTH WILDWOOD NJ 08260 SUSPENSION 6/20/2005 GREENSPAN, BERNARD DO 7/11/1937 1245231406 484 LAFAYETTE STREET HAWTHORNE NJ 07506 DISQUALIFICATION 8/4/2017 PERMANENT GREENSPAN, BERNARD DO 7/11/1937 1245231406 150 OVERLOOK AVENUE, 10C HACKENSACK NJ 07601 DISQUALIFICATION 9/29/2017 PERMANENT

GRETZULA, CHAD DMD 8/23/1972 1558422311 616 EAST LANCASTER BERWYN PA 19312 DISQUALIFICATION 11/20/2015 AVENUE GRIETZER, JOY RN 1/4/1964 406 EAST FRANKLIN STREET WEST BERLIN NJ 08091 DEBARMENT 7/22/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GRIFFIN, CHARLES RPH 9/15/1985 1669757530 HAZELTON USP, PO BOX BRUCETON HILL WV 26525 DISQUALIFICATION 11/20/2015 2000 GRIFFIN, REMY CHHA 4/14/1984 490 PARK AVENUE, APT. 3-B PATERSON NJ 07504 DISQUALIFICATION 5/2/2017

GRIFFITHS, MAI AKA CHHA 9/21/1958 15 PEPPERMINT LANE WILLINGBORO NJ 08046 DISQUALIFICATION 9/29/1999 GRANGER, MAI GRIMES, BRIDGET 1/31/1957 293 LINCOLN STREET PHILLIPSBURG NJ 08865 DEBARMENT 10/29/2012 GRINSHPUN, LEV CHHA 11/26/1956 501-F MORRIS AVENUE ELIZABETH NJ 07208 DEBARMENT 7/22/2017 GRISSON, SANDRA 2/20/1966 30 SOUTH CHURCH STREET, WAYNESBORO PA 17268 DISQUALIFICATION 12/29/2015 APT. 5 GROSS, KENNETH M. DC 1/28/1971 1740488709 333 PROVINCIAL DRIVE MORGANVILLE NJ 07751 DISQUALIFICATION 6/20/2018 GROSSETT II, KENNETH W. RPH 6/22/1945 158 SOUTH DUPONT ROAD CARNEYS POINT NJ 08069 SUSPENSION 3/20/2008 GRULLON, KADIA CHHA 1/5/1990 204 ACKERMAN AVENUE CLIFTON NJ 07011 DISQUALIFICATION 4/19/2018 GUANMESIA, EUNICE AKA RN 7/4/2969 128 FIELDBROOK DRIVE MAGNOLIA DE 19962 DISQUALIFICATION 10/3/2019 MANJO, EUNICE GUENSCH, LISA M. RN 11/2/1966 85 MORNING GLORY ROAD WARREN NJ 07059 DISQUALIFICATION 5/20/2009 GUERRERO, RAUL 10/25/1968 110 JEROME AVENUE SOUTH BOUND NJ 08880 SUSPENSION 1/20/2004 BROOK GUERRERO, THAMARA CHHA 4/11/1972 327 OUTWATER LANE #2 GARFIELD NJ 07026 DISQUALIFICATION 4/6/2018 GUERRIERO, LU ANN M. DC 7/14/1956 21 KILMER DRIVE, STE. 2A MORGANVILLE NJ 07751 SUSPENSION 9/24/1997 GUICE SR., JASON C. 1/30/1944 725 ELIZABETH AVENUE NEWARK NJ 07112 SUSPENSION 9/15/2004 GUICE, AZIE 7/9/1944 725 ELIZABETH AVENUE NEWARK NJ 07112 DEBARMENT 9/5/2005 GUILBERT, RICARDO LPN 4/30/1948 SOUTHERN STATE CORREC DELMONT NJ 08314 DISQUALIFICATION 11/21/1995 FAC GUILIANO, GINA RN 12/16/1977 1 KINDERKAMACK ROAD WOODCLIFF LAKE NJ 07677 SUSPENSION 12/18/2003 GULLA, FRANK T. MD 2/13/1939 113 RTE. 46 W. WILLOW WAYNE NJ 07470 DISQUALIFICATION 12/7/1999 SQUARE GUPTA, NAVEEN RPH 4/11/1943 1700 OAK TREE ROAD EDISON NJ 08820 DEBARMENT 3/4/1999 GUPTA, RASHMI J. COUNSE 6/22/1972 203 HASSE AVENUE PARAMUS NJ 07652 DEBARMENT 7/30/2012 LOR GUPTA, RASHMI J. COUNSE 6/22/1972 10913 CORY LAKE DRIVE TAMPA FL 33647 DEBARMENT 7/3/2013 LOR

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE GUPTA, ROHIT 11/14/1975 BAYSIDE STATE PRISON, PO LEESBURG NJ 08327 DISQUALIFICATION 7/4/2019 #000263228G BOX F-1 GURBAN, ELHAN 10/15/1962 14 FAHRNER STREET BERGENFIELD NJ 07621 DISQUALIFICATION 8/16/2016 GURBAN, ELHAN 10/15/1962 SOUTHERN STATE CF, 4295 DELMONT NJ 08314 DEBARMENT 12/16/2015 RT. 47 GUREVICH, NATALIA MD 11/24/1946 31-23 CRESCENT STREET. APT ASTORIA NY 11106 SUSPENSION 9/20/2005 2C GUSSMAN, MICHAEL DPM 6/7/1959 141 GREENBROOK DRIVE MARLTON NJ 08053 SUSPENSION 6/20/2001 GUYTON, KATHLEEN 2/20/1943 228 SANFORD STREET EAST ORANGE NJ 07018 DISQUALIFICATION 8/20/2002 GUZZI, NICOLE CHHA 6/30/1975 117 SHERIDAN AVENUE ROSELLE PARK NJ 07204 DISQUALIFICATION 7/2/2018 GYAPONG, WILLIAM CHHA 5 LORETTA STREET NEWARK NJ 07112 DISQUALIFICATION 6/29/2019 HABIB, IMAD 7/19/1962 1529 39TH STREET, 1ST FL NORTH BERGEN NJ 07047 DISQUALIFICATION 9/30/2011 HAIDER, MOHAMMED M. 1/15/1966 195 BROADWAY PATERSON NJ 07505 SUSPENSION 12/7/1999 HAINES, KEITH E. MD 5/1/1911 1210 BRACE ROAD CHERRY HILL NJ 08034 DISQUALIFICATION 10/15/1991 DECEASED HAINES, RAMONA L. RN 1/15/1959 103 MEADOWVIEW CIRCLE MARLTON NJ 08053 SUSPENSION 8/19/2004 HAINES, ROBBIE A. RN 4/20/1975 WHITE POND COURT ABSECON NJ 08205 SUSPENSION 10/18/2007 HAITMANEK, OTTILLIE M. LPN 9/5/1968 4162 BAYBERRY COURT MONMOUTH NJ 08852 DISQUALIFICATION 3/28/2017 HALAS, JOHN 6/23/1945 144 WHITEHALL DRIVE VOORHEES NJ 08043 SUSPENSION 5/20/2002 HALL, AFRIKA AKA 8/1/1970 BRIARWOOD DRIVE TOBYHANNA PA 18466 DISQUALIFICATION 10/2/2007 6/28/2018 JACKSON, AFRIKA HALL, ANNA M. RN 10/11/1937 44 LAKE TRAIL EAST WAYNE NJ 07470 SUSPENSION 10/18/2001 HALL, KIM AKA HALL, 11/18/1965 5 UNAMI LANE SCOTCH PLAINS NJ 07076 DISQUALIFICATION 1/23/2009 PERMANENT KIMBERLY AKA TURNER, KIM HAMAD, ALHIBER K. 4/14/1954 100 RESERVOIR AVENUE JERSEY CITY NJ 07307 DISQUALIFICATION 12/1/1998 HAMBERG, IVAN OD 2/11/1934 49 W. CHELTEN AVENUE PHILADEPHIA PA 19144 DISQUALIFICATION 8/27/2001 HAMDAN, AIMAN MD 4/16/1967 1336186600 7 OAK HILL DRIVE WAYNE NJ 07470 DISQUALIFICATION 8/20/2018 HAMDAN, KRISTINA 5/10/1978 7 OAK HILL DRIVE WAYNE NJ 07470 DISQUALIFICATION 11/16/2017 HAMDAN, KRISTINA 5/10/1978 ALDERSON FPC, GLEN RAY ALDERSON WV 21910 DISQUALIFICATION 7/4/2019 #70919-050 ROAD, BOX A HAMED, AHMED 9/17/1977 592 PALISADE AVENUE TEANECK NJ 07666 DISQUALIFICATION 5/20/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE HAMENOO, LOVESDALE CHHA 12/10/1977 1 SKYTOP GARDENS, APT. 19 PARLIN NJ 08859 DISQUALIFICATION 7/16/2019 AKA ADADEVOH, LOVESDALE HAMM, CARRIE RN 3/16/1975 1134 N. STILES STREET LINDEN NJ 07036 SUSPENSION 9/19/2003 2/23/2013 HAMM, CARRIE RN 3/16/1975 1134 N. STILES STREET LINDEN NJ 07036 DEBARMENT 2/23/2010 2/23/2013 HAMPTON, GLYNDA 12/11/1960 571 MONTGOMERY STREET JERSEY CITY NJ 07302 DISQUALIFICATION 3/29/2002

HAN, DANIEL 5/20/1988 481 WALKER STREET, APT. 1D FAIRVIEW NJ 07022 DISQUALIFICATION 11/29/2016

HANDERHAN, LEROY J. RN 9/19/1958 909 ABINGTON ROAD CHERRY HILL NJ 08034 DISQUALIFICATION 5/20/2007 HANDS, EVELYN CHHA 3/20/1956 789 WHEATLAND COURT CAMDEN NJ 08104 DISQUALIFICATION 1/27/2006 HANNA, ALEXANDRA LPN 12/20/1977 51 NORTHRUP DRIVE BRICK NJ 08724 DISQUALIFICATION 5/2/2018 HANNA, ASHRAF PHARM 3/11/1985 50 WILLETT AVENUE SOUTH RIVER NJ 08882 DISQUALIFICATION 11/21/2016 HANNAN, SR., PAUL MD 6/20/1975 1639166572 6619 WALLASTON COURT BROOKLYN NY 11204 DISQUALIFICATION 1/15/2021 HANSCOM, CRYSTAL RPH 1/9/1980 1407 BROMLEY ESTATES PINE HILL NJ 08021 DISQUALIFICATION 8/8/2011 9/6/2016 HARPER, JENNIFER R. RN 12/15/1971 131 HEMLOCK COURT WOODBURY NJ 08096 SUSPENSION 6/19/2003 HARRELL, PAMELA L. RN 4/8/1958 1150 REDROCK CANYON KATY TX 77450 SUSPENSION 8/20/2002 ROAD HARRIGAN, DAVID C. DC 6/14/1952 1932155736 161 W. WHITE HORSE PIKE ABSECON NJ 08201 DISQUALIFICATION 12/29/1995 HARRIS, JOHNNIE 8/20/1983 2 LAKE BOULEVARD EWING NJ 08638 DISQUALIFICATION 4/22/2006 HARRIS, PAUL AKA PATEL, MD 3/13/1965 GB-46 PO BOX 26010 BEAUMONT TX 77720 SUSPENSION 11/20/2006 HARISH HARRISON, RONISHA CHHA 3/22/1995 96 KNIGHTS BRIDGE WAY MAYS LANDING NJ 08330 DISQUALIFICATION 10/9/2018 HARRIS-POOLE, IRENE PTA 7/26/1955 708G LUCAS LANE VOORHEES NJ 08043 DEBARMENT 8/20/2003 HARVILIK, DOROTHEA RN 1/23/1953 20 EAST ALLENDALE ROAD SADDLE RIVER NJ 07458 DISQUALIFICATION 6/28/2017 PERMANENT HASHIM'S MEDICAL PO BOX 930 NEW YORK NY 10013 DISQUALIFICATION 3/26/1994 LIVERY HASSAN, SALAH A. 9/1/1976 105 TONNELLE AVENUE JERSEY CITY NJ 07305 DISQUALIFICATION 5/31/2001 HASSETT, IRENE PHD 12/13/1934 1801894803 950 MORGAN HIGHWAY 226 SOUTH ABINGTON PA 18411 DISQUALIFICATION 11/20/2015 TOWNSHIP HATCHER-MURPHY, LPN 5/5/1971 966 HERMAN DRIVE DEPTFORD NJ 08051 DEBARMENT 7/18/2018 KIMBERLY AKA HURBAN, KIMBERLY

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE HEALTH PHARMACY, INC. 3 POND ROAD PARSIPPANY NJ 07054 DISQUALIFICATION

HEGGS, PAMELA B. 10/22/1963 PO BOX 4004 CLINTON NJ 08809 DISQUALIFICATION 10/18/2007 HELLER, ELLIOT MD 12/24/1957 1770688723 1150 AMBOY AVENUE EDISON NJ 08837 DISQUALIFICATION 4/29/2003 6/25/2014 HENNESSEY, LISA AKA PA 4/20/1970 143737727 10 POSTOL ROAD CREAM RIDGE NJ 08514 DISQUALIFICATION 5/20/2021 LISA KOSTER HENRY, SARA RN 4/22/1975 54 CARVER AVENUE LINDENWOLD NJ 08021 DISQUALIFICATION 3/7/2008 HERMAN, LAWRENCE S. DC 6/25/1966 1881664761 8908 DANVILLE TERRACE FREDERICK MD 21701 DISQUALIFICATION 12/29/2015 HERMAN, THERESA RN 9/30/1948 676 HARBOR ROAD BRICK NJ 08724 SUSPENSION 5/20/2004 HERNANDEZ, JENNIFER CHHA 1/1/1980 1410 OAK TREE DRIVE (H) NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 6/25/2013 HERNANDEZ, NORA LEE LPN 9/28/1980 4820 OLD HARRISBURG GETTYBURG PA 17325 DISQUALIFICATION 11/20/2015 ROAD HERNANDO, GILDA 5/19/1956 669A CHAMBERS STREET TRENTON NJ 08611 DISQUALIFICATION 11/8/2002 HERSCHMAN, ZVI J. MD 1/20/1960 1033217492 346 WILSON STREET WEST HEMPSTEAD NY 11552 DISQUALIFICATION 4/20/2013 HERSCHMAN, ZVI J. MD 1/20/1960 1033217492 1 OLD SHORT HILLS ROAD LIVINGSTON NJ 07039 DEBARMENT 10/28/2013 HERSHAN, DAVID MD 11/13/1956 1740280957 3 OWATONNA STREET HAWORTH NJ 07641 DISQUALIFICATION 5/18/2017 HESSEIN, AMGAD A. MD 10/2/1956 1578637260 483 SOUTH ORANGE AVENUE SOUTH ORANGE NJ 07079 SUSPENSION 1/26/2012 5/25/2016

HESSEIN, AMGAD A. MD 10/2/1956 1578637260 483 SOUTH ORANGE AVENUE SOUTH ORANGE NJ 07079 DEBARMENT 5/25/2016

HESSEIN, AMGAD A. MD 10/2/1956 1578637260 BAYSIDE STATE PRISON, PO LEESBURG NJ 08327 DISQUALIFICATION 5/1/2017 BOX F-1 HEYMACH, GEORGE MD 4/14/1978 1568588317 801 W. 57TH TERRACE KANSAS CITY MO 64113 DISQUALIFICATION 8/27/2001 HEYMAN, JACK DO 12/9/1917 124 E MT. PLEASANT LIVINGSTON NJ 07039 DISQUALIFICATION 1/7/1983 DECEASED AVENUE HHCH HEALTH CARE 1639294812 ALDERSON FEDERAL PRISON ALDERSON WV 24910 DISQUALIFICATION 5/24/2017 CAMP, CLAY GRAY ROAD, BOX A HIBBS, ELIZABETH AKA 9/2/1960 2201 BENJAMIN FRANKLIN PHILADELPHIA PA 19130 DISQUALIFICATION 5/18/2019 O'BRIEN, ELIZABETH PARKWAY, APT. 807 HICKS, MYASIA CHHA 3/27/1995 38-40 JOHNSON AVENUE NEWARK NJ 07108 DISQUALIFICATION 11/8/2017 HIGGINS, GARY W. RN 4/13/1971 548 WAYSIDE ROAD NEPTUNE NJ 07753 SUSPENSION 10/20/2002 HIGGINS, MARTIN 3/12/1943 706 BLOOMFIELD AVENUE NUTLEY NJ 07110 SUSPENSION 7/20/2005

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE HIGGINS, RANDALL T. RPH 6/3/1986 17 WAVERLY PLACE MATAWAN NJ 07747 DISQUALIFICATION 3/3/2017 HILLEY, KATHLEEN M. 1/6/1973 219 CENTER STREET TUCKERTON NJ 08087 DISQUALIFICATION 10/15/2010 HILTON JR., JAMES R. DO 6/15/1961 28 BROCKTON COURT BEACON FALLS CT 06403 DEBARMENT 4/3/2002 HIMMELWRIGHT, VICTOR 3/24/1919 44 LONDONDERRY WAY SUMMIT NJ 07901 DISQUALIFICATION 6/1/1993

HINSON, ANTHONY RN 11/6/1989 566 RECTOR STREET PHILADELPHIA PA 19128 DISQUALIFICATION 5/21/2020 HIRES, STEPHANIE RN 11/18/1972 725 FORD AVENUE LANGHORNE PA 19047 DISQUALIFICATION 2/20/2018 HIRSH, HOWARD RPH 6/6/1952 1811204605 163 EINSTEIN WAY EAST WINDSOR NJ 08512 DISQUALIFICATION 10/25/2016 HO, SHING MD 7/26/1953 6 JAMOR COURT NESCONSET NY 11767 SUSPENSION 10/19/2000 HOCHBERG, JOHN MD 4/10/1952 1134280480 288 PLEASANT VALLEY ROAD MORGANVILLE NJ 07751 DISQUALIFICATION 9/14/2016

HOCHBERG, JOHN MD 4/10/1952 1134280480 288 PLEASANT VALLEY ROAD MORGANVILLE NJ 07751 DISQUALIFICATION 4/17/2017

HODGKISS, KATHLEEN PSYCH 7/13/1977 1013179233 151 KNOLLCROFT ROAD LYONS NJ 07939 DEBARMENT 7/22/2017 HOFFMAN, KATHLEEN LPN 9/15/1971 99 CREEK ROAD BRICK NJ 08724 DISQUALIFICATION 9/13/2018 AKA SULIMENKO- HOFFMAN, KATHLEEN HOFFMAN, MARTIN L. MD 8/22/1948 7 CAREFREE LANE SUFFERN NY 10901 DEBARMENT 3/29/2002 HOFFSPIEGEL, PAUL 9/23/1940 56 SULLLIVAN DRIVE WEST ORANGE NJ 07052 SUSPENSION 8/6/1998 HOFSTETTER, DAVID 2/25/1930 114 COUNTY ROAD 513 PITTSTOWN NJ 08867 SUSPENSION 6/14/2000 HOLCA, LIVIU MD 1/25/1958 1053348417 1137 BEACON AVENUE MANAHAWKIN NJ 08050 SUSPENSION 11/25/2014 HOLLEY, AKEYA CHHA 8/19/1987 11 MONTICELLO AVENUE, NEWARK NJ 07106 DISQUALIFICATION 7/13/2018 2ND FL HOLLOWAY, JAZMINE CHHA 2/12/1995 95 CUMMINGS AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 1/23/2018 HOLLOWAY, LAKEZIA CHHA 2/16/1982 1306 SUMMERFIELD AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 7/13/2018

HOLLOWAY, QUINCEY LSW 3/21/1975 447 EAST 42ND STREET PATERSON NJ 07504 DISQUALIFICATION 1/17/2019 4/24/2019 HOLMES, THERESA CHHA 2/20/1986 1290 N. 27TH STREET CAMDEN NJ 08105 DISQUALIFICATION 2/12/2018 8/20/2018 HOMAN, WALTER W. CHHA 11/25/1959 FORECASTLE AVENUE BEACHWOOD NJ 08722 SUSPENSION 8/21/2008 HOME CARE SOLUTIONS 216 NORTH AVENUE E, STE. CRANFORD NJ 07016 SUSPENSION 1/24/2014 2 HONG, JOSEPH S. MD 1/1/1964 1346258001 34 FOREST DRIVE WATCHUNG NJ 07069 DISQUALIFICATION 9/29/2016

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE HOPKINS, TONYA CHHA 1/13/1972 433 EAST 18TH STREET, 2ND PATERSON NJ 07524 DISQUALIFICATION 9/20/2019 FL HOPPE, GERALD 3/15/1940 BOX 483A, RD 1 MONROEVILLE NJ 08343 DISQUALIFICATION 6/1/1993 HORN, MURRAY 7/3/1919 287 GARFIELD AVENUE HAWORTH NJ 07641 DISQUALIFICATION 8/9/1984 HORVATH, CHARLYN RN 7/12/1967 3072 BORDENTOWN PARLIN NJ 08859 DISQUALIFICATION 3/27/2018 AVENUE HORWITZ, KENNETH R. RPH 4/19/1962 8 MOHAWK PLACE RANDOLPH NJ 07869 DEBARMENT 10/31/2003 7/20/2011 HOUSTON, PLATINUM CHHA 1/19/1992 15 COURTLAND LANE WILLINGBORO NJ 08046 DISQUALIFICATION 9/19/2017 HOUTAN, FARAH PTA 7/23/1957 269 STEELMANVILLE ROAD EGG HARBOR NJ 08234 SUSPENSION 10/27/2009 HOUTAN, FARAH PTA 7/23/1957 269 STEELMANVILLE ROAD EGG HARBOR NJ 08234 DEBARMENT 5/1/2012 HOWARD, REGINA R. 9/6/1989 104 E. 8TH STREET LAKEWOOD NJ 08701 DISQUALIFICATION 10/30/2013 HOWARD, ROBIN A. RN 2/14/1962 196 KING AVENUE TRENTON NJ 08638 DISQUALIFICATION 7/19/2001 HOWELL, BRIAN LPN 7/11/1975 106 PARKER AVENUE #2 FORKED RIVER NJ 08731 DISQUALIFICATION 7/27/2017 HOWELL, CHRISTOPHER CHHA 5/24/1991 978 JOLSON COURT MANCHESTER NJ 08759 DEBARMENT 10/26/2017 HOWELL, CLIFTON MD 10/15/1956 1942247622 15 COLONY DRIVE WEST WEST ORANGE NJ 07052 DISQUALIFICATION 8/19/2011 HOWELL, CLIFTON MD 10/15/1956 1942247622 15 COLONY DRIVE WEST WEST ORANGE NJ 07052 DEBARMENT 10/18/2012 HRABARCHUK, EUGENE MD 8/29/1920 925 CLIFTON AVENUE CLIFTON NJ 07013 DISQUALIFICATION 12/1/1998 HSIA, VINCENT RPH 10/5/1959 1710209291 FCI SCHUYLKILL MINERSVILLE PA 17954 DISQUALIFICATION 5/1/2014 HU, HSUN TUAN 2/17/1938 154 HOMESTEAD PLACE BOGOTA NJ 07603 DISQUALIFICATION 5/10/1999 HUBBARD, PETER RN 3/6/1960 1051 WASHINGTON STREET EASTON PA 18042 DISQUALIFICATION 10/25/2016

HUDSON, FITZGERALD MD 5/25/1960 1639367725 PO BOX 1000 MILAN MI 48160 DEBARMENT 6/12/2014 HUERTA JR., FRANK 8/27/1973 25 CHAPEL STREET BROOKLYN NY 11201 SUSPENSION 1/10/1997 HUNDA, RAFAEL MD 9/3/1920 472 RIVER STREET PATERSON NJ 07524 DISQUALIFICATION 9/21/2001 HUNTER, CHRISTOPHER LPN 4/23/1961 430 BARTINE STREET SOMERVILLE NJ 08876 SUSPENSION 6/20/2002 HUNTER, FRANK L. 7/5/1964 6 HARTZ DRIVE BRIDGETON NJ 08302 SUSPENSION 2/20/2005 HURBAN, KIMBERLY AKA LPN 5/5/1971 966 HERMAN DRIVE DEPTFORD NJ 08051 DEBARMENT 7/18/2018 HATCHER-MURPHY, KIMBERLY HURLEY, DOUGLAS 11/25/1979 FCI FAIRTON, PO BOX 420 FAIRTON NJ 08320 DISQUALIFICATION 5/18/2019 #65501-050 HUSSAIN, IFTIKHAR 6/12/1966 9 VAN COURTLAND AVENUE STATEN ISLAND NY 10301 DISQUALIFICATION 1/29/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE HUSSAIN, ZAHID MD 12/3/1974 1992733232 301 ROUTE 9 NORTH FREEHOLD NJ 07728 SUSPENSION 9/30/2011 7/22/2016 HUSSKE, JULIE RN 12/18/1980 1105 CRENDALL WAY WAKE FOREST NC 27587 DISQUALIFICATION 11/10/2019 HUSTON JR., JOHN A. CHHA 9/18/1956 8 PRODUCTION WAY AVENEL NJ 07001 SUSPENSION 8/29/1997 HYMAN, DEBORAH 7/23/1954 6 HASTINGS LANE FLEMINGTON NJ 08822 SUSPENSION 8/20/2006 HYMAN, RONALD M. RPH 2/1/1961 3845 DEMPSEY HUNTINGTON VALLEY PA 19006 SUSPENSION 1/19/2005

I & I INVALID COACH 85 CENTRAL AVENUE CLIFTON NJ 07015 SUSPENSION 2/19/2004 IBRAHIM, ELHADI 4/3/1964 125 HALF MILE ROAD, BOX MIDDLETOWN NJ 07748 DEBARMENT 1/29/2001 190 IBRAHIM, GASIM 10/25/1963 340 FAIRMOUNT JERSEY CITY NJ 07306 DISQUALIFICATION 12/11/1996 IBRAHIM, MOHAMMAD MD 8/14/1966 1265494645 871 MCBRIDE AVENUE WOODLAND PARK NJ 07424 DEBARMENT 1/22/2016 IGBERASE, CHARLES AKA RN 4/17/1962 14909 DOWNEY COURT, BOWIE MD 20721 DISQUALIFICATION 5/20/2018 IGBERASE, OLUWAFEMI SUITE 200

IGBINADUWA, NEWTON RPH 6/20/1955 116-35 139TH STREET JAMAICA NY 11436 SUSPENSION 5/19/2005 IGHAMA-AMEGOR, MD 3/12/1962 1639251804/ 59 MAPLE AVENUE VAUXHALL NJ 07088 DISQUALIFICATION 8/16/2017 IBILOLA 1659453173 IGHAMA-AMEGOR, MD 3/12/1962 1639251804/ 204 KEER AVENUE NEWARK NJ 07112 DISQUALIFICATION 5/18/2019 IBILOLA 1659453173 IGNACCOLO, EMANUEL MD 3/9/1932 688 WYCOFF AVENUE MAHWAH NJ 07430 DISQUALIFICATION 6/1/1993 DECEASED IKEH, CHIDI ETHELBER 11/3/1962 PO BOX 26030 BEAUMONT TX 77720 DISQUALIFICATION 3/9/2008 ILEM, PRISCILLA G. MD 6/14/1927 1699860684 782 ALPS ROAD WAYNE NJ 07470 DISQUALIFICATION 10/27/2013 ILLINGWORTH, DONNA LPN 8/20/1959 1505 CLAIRE ROAD FORKED RIVER NJ 08731 SUSPENSION 5/19/2005 INFINITE CARE, INC. 1073549671 6423 RISING SUN AVENUE PHILADELPHIA PA 19111 DISQUALIFICATION 12/29/2015 INGALLS, ANDREA CHHA 10/7/1989 36 NORWOOD STREET, 3RD NEWARK NJ 07106 DISQUALIFICATION 4/19/2018 FLOOR INNES JR., GEORGE MD 1/16/1961 1736 EAST GENESEE STREET FAYETTEVILLE NY 13066 SUSPENSION 7/20/2005 MICHAEL INNOCENZI, ANTHONY DPM 12/14/1969 1255336079 7972 AQUADALE DRIVE YOUNGSTOWN OH 44512 DISQUALIFICATION 12/29/2015 INSABELLA, HARRY DDS 2/5/1958 591 SOMERSET STREET SOMERSET NJ 08873 DISQUALIFICATION 7/1/1997 INTELISANO, RONALD DO 12/28/1961 1235200775 46 BUCKINGHAM DRIVE BERLIN NJ 08009 DISQUALIFICATION 3/3/2017 INTELISANO, RONALD DO 12/28/1961 1235200775 1504 BLACKWOOD BLACKWOOD NJ 08012 DISQUALIFICATION 12/29/2017 CLEMENTON ROAD

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE IOSIM, ANATOLY CHHA 9217 FALSTON CIRCLE OLD BRIDGE NJ 08857 DEBARMENT 1/20/2017 IQBAL, MOHAMMED S. MD 11/1/1947 1972564078 735 LINWOOD AVENUE RIDGEWOOD NJ 07450 DEBARMENT 9/12/2008 IRBY, ARCHER DC 10/15/1970 1801927520 115 GRAND AVENUE ENGLEWOOD NJ 07631 DISQUALIFICATION 10/25/2016 IRVING, EDWARD J. 5/14/1969 202 SEYMOUR AVENUE NEWARK NJ 07108 SUSPENSION 4/20/2004 ISAACSON, STEVEN RPH 10/7/1944 1959 BIRCHWOOD PARK CHERRY HILL NJ 08034 DISQUALIFICATION 4/6/1995 DRIVE ISMAIL, MOHAMMAD RPH 1/25/1957 4 GRAHAM COURT PARSIPPANY NJ 07054 SUSPENSION 12/18/2003 IVASHENKO, ALEXANDER PT 5/10/1957 1134289796 31 GOLDSMITH DRIVE HOLMDEL NJ 07333 SUSPENSION 5/25/1999

IYENGAR, DEVARAJAN MD 7/22/1953 1689620700 27 EAST 29TH STREET BAYONNE NJ 07002 SUSPENSION 8/25/2015 1/10/2017 J & S PHARMACY 214 SECOND STREET ELIZABETH NJ 07207 DISQUALIFICATION 12/1/1998 J & S PHARMACY 214 SECOND STREET ELIZABETH NJ 07207 SUSPENSION 7/11/1997 JACKSON, AFRIKA AKA 8/1/1970 BRIARWOOD DRIVE TOBYHANNA PA 18466 DISQUALIFICATION 10/2/2007 6/28/2018 HALL, AFRIKA JACKSON, AMINATU CHHA 6/4/1996 26 JAMES STREET, C12 LAKEWOOD NJ 08701 DISQUALIFICATION 2/8/2017 JACKSON, DESHONETTE CHHA 4/18/1992 419 EAST 27TH STREET, 2ND PATERSON NJ 07515 DISQUALIFICATION 4/19/2018 FLOOR JACKSON, GEORGE D. PSYCH 8/20/1928 367 FAIRVIEW AVENUE ORANGE NJ 07050 DISQUALIFICATION 6/30/1997 JACKSON, MAKEBA CHHA 1/24/1976 15 MILL STREET EATONTOWN NJ 07724 DISQUALIFICATION 7/14/2017 JACKSON, ZEKIA CHHA 3/7/1988 232 JUSTIN WAY WILLIAMSTOWN NJ 08094 DISQUALIFICATION 10/19/2017 JACKSON-GILLARD, CHHA 6/16/1990 3 BORDEN AVENUE, APT. 8 ASBURY PARK NJ 07712 DISQUALIFICATION 4/24/2018 CRYSTALYNN JACOBS, AMY LPN 9/27/1972 620 MOUNTAIN ROAD BUTLER NJ 07405 DISQUALIFICATION 6/5/2017 JACOBSON, CRAIG DC 11/17/1965 1219 LIBERTY AVENUE HILLSIDE NJ 07205 DISQUALIFICATION 3/24/2000 DECEASED JACOBSON, DEBRA 2/6/1969 661 RT. 9 BAYVILLE NJ 08721 DISQUALIFICATION 1/25/2011 1/25/2013 JACOBSON, JAY P. DC 5/23/1943 1508084385 25 DEER PATH HOLMDEL NJ 07733 DISQUALIFICATION 4/12/1996 JACQUES, ARNOLD, J. MD 10/15/1949 1124170899 31 BRIDGEWATER COURT JACKSON NJ 08527 DISQUALIFICATION 7/30/2011 JACQUEZ, MADELIN CHHA 11/4/1993 2141 SOUTH CLINTON HAMILTON NJ 08610 DISQUALIFICATION 2/12/2018 AVENUE JAFARI, MARYAM MD 9/16/1970 1831276880 80 LINDEN STREET, APT. M MILLBURN NJ 07041 DISQUALIFICATION 9/20/2014

JAFARI, MARYAM MD 9/16/1970 1831276880 176 BLOOMFIELD AVENUE NEWARK NJ 07104 SUSPENSION 2/22/2012 JAFFERY, SYED MD 7/8/1961 1235153685 109 TROTTER ROAD EGG HARBOR NJ 08234 DEBARMENT 2/15/2016

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE JAGTIANI, RAJA MD 5/31/1961 1659320281 11 ONTARIO STREET DUMONT NJ 07628 SUSPENSION 6/6/2016 11/29/2016 JAGTIANI, RAJA MD 5/31/1961 1659320281 11 ONTARIO STREET DUMONT NJ 07628 DEBARMENT 9/28/2015 JAGTIANI, RAJA MD 5/31/1961 1659320281 46 MOORSGATE CIRCLE 1 EAST WINDSOR NJ 08520 DISQUALIFICATION 3/5/2019 JAKUBCZAK, ARTHUR F. DC 6/3/1952 1053493718 465 RATHBURN PLACE PERTH AMBOY NJ 08861 SUSPENSION 1/18/2001 10/26/2001 JAMES, EDWARD DO 7/27/1926 1598789703 505 GROVE STREET, APT. 21 SEWICKLEY PA 15143 DISQUALIFICATION 11/20/2015

JAMES, GLORIA M. RN 10/3/1942 18 LINDEN COURT JERSEY CITY NJ 07305 SUSPENSION 7/20/2005 JAMES, SULENNY CHHA 9/24/1979 293-295 BROAD STREET, 2ND NEWARK NJ 07104 DISQUALIFICATION 2/27/2017 FL JAMISON, ROBERT W. DO 4/4/1945 79 PARTRIDGE LANE CHERRY HILL NJ 08003 DEBARMENT 9/11/2000 JANOF, ROY 502 WASHINGTON STREET HOBOKEN NJ 07030 DISQUALIFICATION 1/9/1983 JANVIER-PIERRE, MARY 10/16/1968 6400 BRIDGEPORT LANE LAKE WORTH FL 33463 DEBARMENT 5/20/2012 JARMON, ROBERT G. MD 11/17/1943 8 BRIGHTON AVENUE SPRING LAKE NJ 07762 DEBARMENT 5/9/2002 JASCALEVICH, MARIO E. MD 8/27/1927 10 PRISCILLA LANE ENGLEWOOD CLIFF NJ 07632 DISQUALIFICATION 6/1/1993 DECEASED JASINSKI, DARIUS DPM 3/17/1975 1013995182 1225 MCBRIDE AVENUE WOODLAND PARK NJ 07424 DEBARMENT 12/29/2016 9/22/2020 JASPER, SARAH CHHA 1/6/1985 187 SIERRA COURT WOODBRIDGE NJ 07095 DISQUALIFICATION 1/31/2017 JASPER, THEODORE MD 1/1/1958 1528171972 1010 CLIFTON AVENUE CLIFTON NJ 07013 DEBARMENT 8/12/2015 JASPER, THEODORE MD 1/1/1958 1528171972 1010 CLIFTON AVENUE CLIFTON NJ 07013 DEBARMENT 12/16/2015 JASZCZULT, JOAN E. DO 6/29/1961 50 NEWARK AVENUE, APT BELLEVILLE NJ 07109 DEBARMENT 2/3/2006 309 JAVID, MOHAMMAD A. 3/21/1953 E. JERSEY STATE PRISON RAHWAY NJ 07065 SUSPENSION 8/20/2000 JAVID, MOHAMMED A. 3/21/1953 63 FEDERAL STREET METUCHEN NJ 08840 DISQUALIFICATION 4/11/1996 JAYARAM, AJIT MD 12/20/1947 1295773869 215 SOUTH BURLINGTON BRIDGETON NJ 08302 DISQUALIFICATION 8/20/2013 ROAD JAYARAM, AJIT MD 12/20/1947 1295773869 215 SOUTH BURLINGTON BRIDGETON NJ 08302 DISQUALIFICATION 4/4/2014 ROAD JEAN-BAPTISTE, MD 1/3/1973 1831227719 775 MOUNTAIN WATCHUNG NJ 07069 SUSPENSION 9/19/2011 DECEASED DEMESVAR A. BOULEVARD, STE. 1 JECK, CHARLES N. DO 6/3/1959 1 CHICKORY PLACE NEWTOWN PA 18940 SUSPENSION 7/5/2002 JEDJU, LINDA RN 3/11/1954 33 NINTH STREET, PO BOX FLAGSTOWN NJ 08821 DISQUALIFICATION 11/27/2016 8/31/2018 644 JEFFERSON, MICHAEL K. DMD 8/12/1954 1811956238 408 PADDOCK COURT SEWELL NJ 08080 DISQUALIFICATION 8/16/2016 5/12/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE JEFFRIES, MARC 9/5/1964 2 MILLER LANE WHITEHOUSE NJ 08889 DISQUALIFICATION 3/13/2014 STATION JELKS, SAMARRA CHHA 3/9/1982 3309 RIDGEWAY ROAD MANCHESTER NJ 08759 DISQUALIFICATION 3/8/2017 JEMINI, DAVID 2/1/1952 PO BOX 280, HWY. 698 FAIRTON NJ 08320 SUSPENSION 7/18/2002 JEMINI, JACK 7/15/1950 PO BOX 600 ELGIN FL 32542 SUSPENSION 7/18/2002 JIMENEZ, CRISTIAN RN 1/5/1995 61 CHESTNUT STREET, APT. ONEONTA NY 13820 DEBARMENT 6/10/2019 3C JIMENEZ, JOSE COUNSE 6/27/1955 EXTENSION VILLA RITA SAN SEBASTIAN PR 00685 SUSPENSION 12/8/2003 12/8/2011 LOR JIMS TRANSPORTATION 49 WESTERN PARKWAY IRVINGTON NJ 07111 SUSPENSION 4/11/2006 JOACHIM, LEONARD MD 3/10/1950 1720023005 26 LAKE DRIVE MOUNTAIN LAKES NJ 07046 DISQUALIFICATION 12/5/1997 JOACHIM, LEONARD MD 3/10/1950 1720023005 25 HIDEAWAY LANE SPARTA NJ 07871 DISQUALIFICATION 5/15/2017 JOACHIM, STEPHANIE CHHA 10/7/1990 15 LINDSLEY PLACE, APT. 1R EAST ORANGE NJ 07018 DISQUALIFICATION 1/31/2017

JODELKA, ERIK RPH 8/18/1980 1003103946 391 BEECROFT PLACE OAKHURST NJ 07755 DEBARMENT 8/20/2006 2/23/2011 JOHNSON, ALICIA LPN 6/4/1985 20 SKYTOP GARDENS PARLIN NJ 08859 DISQUALIFICATION 9/12/2016 JOHNSON, BEVERLY M. CHHA 2/3/1957 909 ARMSTRONG ASBURY PARK NJ 07712 DISQUALIFICATION 7/17/2018 BOULEVARD, APT 3A JOHNSON, BRENDA C. LPN 9/24/1973 232 OAK STREET WILLIAMSTOWN NJ 08094 SUSPENSION 1/19/2003 JOHNSON, DEMETRIA CHHA 9/29/1993 21 ROSA PARK BOULEVARD PATERSON NJ 07524 DISQUALIFICATION 7/31/2017 JOHNSON, DENISE M. RN 11/28/1954 12 SIOUX TRAIL DENVILLE NJ 07834 SUSPENSION 4/20/2005 JOHNSON, DUWANA L. CHHA 3/10/1969 213 MARTIN LUTHER KING LAKEWOOD NJ 08701 SUSPENSION 9/14/2005 DRIVE JOHNSON, JULIE ANN CHHA 11/19/1958 1145 MANTUA PIKE MANTUA NJ 08051 SUSPENSION 6/19/2001 JOHNSON, KIM E. LPN 10/20/1961 6B JANS WAY BYRAM TOWNSHIP NJ 07821 DISQUALIFICATION 11/16/2017 JOHNSON, LARHONDA CHHA 10/15/1984 1704 CENTENNIAL VILLAGE CAMDEN NJ 08105 DISQUALIFICATION 2/8/2017 JOHNSON, MICHAEL LPN/RN 5/9/1986 899 DIANE COURT WOODBRIDGE NJ 07095 DISQUALIFICATION 3/28/2017 JOHNSON, ROBERT D. 6/5/1945 1608 4TH AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 1/6/2006 JOHNSTON, KELLIE RN 12/26/1970 1697 SYLVAN DRIVE BLUE BELL PA 19422 SUSPENSION 10/19/2006 JOHNSTON, MICHAEL MFT 10/4/1960 1780999847 SCI CAMP HILL, PO BOX 200 CAMP HILL PA 17001 DISQUALIFICATION 9/29/2017 #MC4261 JONES, ANIECE LPN 8/20/1984 625 DREXEL AVENUE ATLANTIC CITY NJ 08401 DEBARMENT 6/4/2018 JONES, CYNTHIA R. RN 4/1/1955 1089 HAWSER AVENUE MANAHAWKIN NJ 08050 SUSPENSION 8/20/2002

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE JONES, DAVID W. LPN 6/27/1952 97 LINCOLN PARK NEWARK NJ 07102 SUSPENSION 3/20/2003 JONES, IMAJE CHHA 4/13/1993 287 ABLETT VILLAGE CAMDEN NJ 08105 DISQUALIFICATION 2/8/2017 JONES, JASMINE CHHA 2/21/1991 304 ERIAL ROAD SICKLERVILLE NJ 08081 DISQUALIFICATION 2/8/2017 JONES, KEVIN PHARM 8/3/1992 734 STERLING STREET PLAINFIELD NJ 07062 DISQUALIFICATION 7/22/2017 TECH JONES, MICHELLE N. 11/26/1983 446 PROSPECT STREET-B16 LAKEWOOD NJ 08701 SUSPENSION 9/30/2005 11/25/2019 JONES, ROSALIN CHHA 11/30/1970 159 PFEIFFER STREET CAMDEN NJ 08105 DISQUALIFICATION 2/20/2017 JONES, VANESSA A. CHHA 7/30/1989 156 NORTH 18TH STREET EAST ORANGE NJ 07017 DEBARMENT 7/17/2018 JONES-HATTOH, CHHA 7/8/1984 3 ROANOKE AVENUE, APT. 2C NEWARK NJ 07108 DISQUALIFICATION 1/23/2018 CHATIQUA JONES-PRICE, 10/17/1965 PO BOX 1006 WENDELL NC 27591 DISQUALIFICATION 6/1/2000 ANTIONETTE JONES-PRICE, 10/17/1965 120 S. 20TH STREET IRVINGTON NJ 07111 SUSPENSION 3/16/1998 ANTOINETTE JOO, EUI D. MD 11/15/1939 29 TIP TOP WAY BERKELEY HEIGHTS NJ 07922 DISQUALIFICATION 10/14/1985 JORDON, SANDRA LPN 4/26/1966 15 CANIS COURT SEWELL NJ 08080 DISQUALIFICATION 6/5/2017 JOSE, DELIA V. 9/30/1955 185 S. EUCLID STREET, SUITE PASADENA CA 91101 SUSPENSION 4/22/1997 111 JOSEPH, ALEX CHHA 11/21/1982 1531 SEWALL AVENUE #2 ASBURY PARK NJ 07712 DISQUALIFICATION 6/26/2018 JOSHI, JAYENDRA B. 9/13/1959 95-05 37TH AVENUE, APT. 1- JACKSON HEIGHTS NY 11373 DISQUALIFICATION 6/4/1997 A JOSHI, KAJALBEN LPN 8/25/1992 476 EBONY TREE AVENUE GALLOWAY NJ 08205 DISQUALIFICATION 3/12/2018 JOY, RENEE RN 3/29/1968 34 LUTHER ALLEN LANE BRUSH CREEK TN 38547 DISQUALIFICATION 11/16/2017 JOYNER, VALERIE CHHA 7/8/1991 19 SCHIRRA DRIVE WANAQUE NJ 07465 DEBARMENT 6/18/2018 JRMICK, INC. 911 MAIN STREET BELMAR NJ 07719 DISQUALIFICATION 1/16/2005 JUISTON, PEGGY A. 10/19/1946 17 MYRTLE AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 6/5/2000 JUNGER, SYLVAIN S. MD 4/29/1956 1497975551 270 PENNINGTON AVENUE PASSAIC NJ 07055 DISQUALIFICATION 4/20/2011 JUPITER, RONALD DDS 9/29/1950 1023125879 119 EYLAND AVENUE SUCCASUNNA NJ 07876 DISQUALIFICATION 5/5/2014 JUPITER, RONALD DDS 9/29/1950 1023125879 119 EYLAND AVENUE SUCCASUNNA NJ 07876 DEBARMENT 4/15/2016 JURGENSON, THEODORE DPM 6/18/1928 438 BROADWAY LONG BRANCH NJ 07746 DISQUALIFICATION 6/1/1993 DECEASED W. JYAMFI, CHARLES RPH 9/24/1953 71 OLD SHORT HILLS ROAD WEST ORANGE NJ 07052 SUSPENSION 3/22/2006

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KADISHA, INC. 667 MOUNT PROSPECT NEWARK NJ 07104 SUSPENSION 5/14/1998 STREET KAHONU, ANNE N. 12/19/1985 315 MILL STREET SOUTH PLAINFIELD NJ 07080 DEBARMENT 1/19/2013 KAJI, VIKRAM MD 11/12/1935 1346326634 310 COVE LANE BEACH HAVEN NJ 08008 DISQUALIFICATION 4/10/2019 PERMANENT KALFUS, DENIS H. DPM 12/9/1945 1015 EAST GLEN AVENUE WASHINGTON NJ 07606 SUSPENSION 6/19/2003 DECEASED TOWNSHIP KALINOSKI, STEPHEN RPH 8/21/1963 178 KINGFISHER DRIVE MIDDLETOWN NJ 07748 DISQUALIFICATION 9/20/2018 KALINOWSKI, KAROL RN 5/11/1984 31 COVINGTON LANE VOORHEES NJ 08043 DISQUALIFICATION 3/28/2017 11/18/2019 KALLEN, HERBERT 10/26/1919 274 RIVER ROAD ST JAMES ISLAND NY 11780 DISQUALIFICATION 6/1/1993 KAMARA, HELEN H. CHHA 3/9/1964 PO BOX 509 PALMYRA NJ 08065 SUSPENSION 10/20/2002 KANE, TINA APN/RN 11/27/1967 1366688079 157 EVERGREEN AVENUE VILLAS NJ 08251 DISQUALIFICATION 11/9/2019 KANEVSKY, ZHANNA MD 6/6/1961 1073551065 28 KEPPEL AVENUE #10307 STATEN ISLAND NY 10307 DISQUALIFICATION 2/4/2014 PERMANENT KANG, BYUNG MD 1/1/1940 1164599213 122 LONG HILL ROAD LITTLE FALLS NJ 07424 DISQUALIFICATION 9/23/2016 KANIA, RAMESHCHAN MD 12/14/1952 1235158403 310 CENTRAL AVENUE, SUITE EAST ORANGE NJ 07018 DISQUALIFICATION 1/20/2014 10/3/2019 106 KANIA, RAMESHCHAN MD 12/14/1952 1235158403 310 CENTRAL AVENUE, SUITE EAST ORANGE NJ 07018 SUSPENSION 2/22/2012 10/3/2019 106 KANKAM, MARTIN 13 G READING ROAD EDISON NJ 07083 DEBARMENT 7/30/2005 KANZ JR., JOHN T. RPH 12/21/1947 136 HILLCREST AVENUE HILLTOP NJ 07542 DISQUALIFICATION 9/17/1984 KAPLAN, DONALD DPM 12/4/1948 1952433567 701 PALMER AVENUE ALLENHURST NJ 07711 SUSPENSION 3/25/2010 KAPLAN, HARMON B. DDS 7/28/1949 1093991044 1251 PATERSON PLANK SECAUCUS NJ 07094 DISQUALIFICATION 8/26/1988 ROAD KARASEK, ROBERT D. DMD 4/11/1963 1689794042 559 PLAINFIELD AVENUE BERKELEY HEIGHTS NJ 07922 DISQUALIFICATION 11/20/2014 KARASEK, ROBERT D. DMD 4/11/1963 1689794042 64 DOCKSIDE DRIVE SOMERS POINT NJ 08244 DISQUALIFICATION 9/19/2016 KARES, FRANCIS R. RPH 2/8/1950 615 SUMMIT ROAD UNION NJ 07083 DISQUALIFICATION 2/16/1983 2/16/1991 KARFUNKEL, DAVID M. 10/12/1970 100 HOWARD AVENUE PASSAIC NJ 07055 DISQUALIFICATION 4/2/2008 10/25/2013 KARGE, FREDRICK PO BOX 190 AVENEL NJ 07001 SUSPENSION 1/28/2007 KARNER, ANNA EMT 11/2/1982 17 MAPLE AVENUE PINE BROOK NJ 07058 DISQUALIFICATION 7/23/2002 KARSHENBOYM, 8/7/1961 90 WEST HILL ROAD WOODCLIFF LAKE NJ 07677 DEBARMENT 9/20/2007 ALEXANDER KAUFMAN, SHOSHANA LCSW 11/10/1977 349 JESTER COURT OLD BRIDGE NJ 08857 DISQUALIFICATION 7/15/2009 11/7/2014 AKA STOCKELBERG, SHOSHANA

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KAVROS, STEVEN J. DPM 7/22/1954 1316912801 12 HERITAGE COURT CHERRY HILL NJ 08034 DISQUALIFICATION 6/1/1993 8/22/2019 KAWAM JABAKJI, MD 1/27/1959 1760541312 6 BARKER PLACE WAYNE NJ 07470 DEBARMENT 5/16/2016 MOHAMED KAWAM JABAKJI, MD 1/27/1959 1760541312 6 BARKER PLACE WAYNE NJ 07470 DISQUALIFICATION 7/20/2017 MOHAMED KAY, KWAME CHHA 7/1/1985 PO BOX 961186 MIAMI FL 33296 DISQUALIFICATION 2/8/2017 KEE, TERRAYA C. CHHA 7/25/1985 CLINTON STREET CAMDEN NJ 08105 DISQUALIFICATION 11/30/2007 KEELEN, SUSAN RN 6/7/1965 272 OLD YORK ROAD FLEMINGTON NJ 08822 SUSPENSION 6/20/2001 1/27/2012 KEENEY, RICHARD DC 6/29/1946 1255461430 112 BALTIMORE STREET HANOVER PA 17331 DISQUALIFICATION 12/29/2015 KELLEY, JANINE RN 4/19/1981 126 S. LECATO AVENUE AUDOBON NJ 08106 DISQUALIFICATION 2/2/2018 PERMANENT KELLOGG, WILLIAM T. MD 4/29/1946 47 MAPLE STREET, STE. 204 SUMMIT NJ 07901 DISQUALIFICATION 1/9/1996 2/28/2014 KELLUM, BETZAIDA CHHA 10/20/1987 1936 S. 8TH STREET, APT. CAMDEN NJ 08104 DISQUALIFICATION 2/8/2017 B13 KELLUM, EARLENE CHHA 5/25/1978 279 S. BLACKHORSE PIKE MOUNT EPHRAIM NJ 08059 DISQUALIFICATION 3/5/2018 KELLY, MICHELLE S. CNA 11/22/1961 963 PARK AVENUE PLAINFIELD NJ 07060 DEBARMENT 3/24/2002 KELLY-UPPER, DENISE 7/21/1955 2200 ATLANTIS AVENUE MAYS LANDING NJ 08330 DISQUALIFICATION 12/1/1998 KEMENY, GEORGE MD 5/11/1951 39 THIRD STREET ELIZABETH NJ 07206 DISQUALIFICATION 11/22/1977 KEMOKAI, JOSEPHINE LPN 12/27/1955 29 BENNETT AVENUE RANDOLPH NJ 07869 DISQUALIFICATION 11/21/2016 KENDRICK, SOPHIA CHHA 7/14/1991 4 OAK WALK CAMDEN NJ 08104 DISQUALIFICATION 7/17/2018 KENNEALLY, RN 7/26/1990 1308 NOREEN DRIVE BURLINGTON NJ 08016 DISQUALIFICATION 9/30/2019 CHRISTOPHER KEREKES, KEVIN #65504- 12/5/1965 FCI SCHUYKILL, PO BOX 759 MINERSVILLE PA 17954 DISQUALIFICATION 3/1/2019 050 KESHISHIAN, PAUL DO 6/25/1951 1437207610 625 COBH ROAD RIVER VALE NJ 07675 DEBARMENT 4/22/1999 3/15/2000 KEYES, DONNA CHHA 6/25/1976 4433 EAST MILLS ROAD MAPLE SHADE NJ 08052 DISQUALIFICATION 2/20/2017 KHAIR, IMADELIN A. 12/30/1959 160 ALABAMA AVENUE PATERSON NJ 07505 SUSPENSION 1/28/2001 KHAIR, IMADELIN A. 12/30/1959 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 5/24/2017 KHAJAVI, ABDOLALI MD 1/1/1931 HIGHWAY 94 & OSBOW LANE FRANKLIN NJ 07416 DEBARMENT 8/20/1999

KHAN, ASIF ALI 8/31/1961 909A BROAD STREET NEWARK NJ 07102 SUSPENSION 6/5/1996 KHAN, AZAM HAYAT 1/18/1962 687 FRELINGHUYSEN NEWARK NJ 07114 SUSPENSION 12/16/1998 AVENUE

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KHAN, AZAM HAYAT 1/18/1962 687 FRELINGHUYSEN NEWARK NJ 07114 DISQUALIFICATION 10/21/1999 AVENUE KHAN, AZAM HAYAT 1/18/1962 107 CHARLESTON AVENUE STATEN ISLAND NY 10309 DISQUALIFICATION 7/7/2008 KHAN, MUNIR 8/15/1953 238 GRAND STREET, APT. 1 JERSEY CITY NJ 07302 DEBARMENT 8/20/2009 KHAN, SALEEM M. 9/19/1967 336 2ND STREET, APT. 1 JERSEY CITY NJ 07302 SUSPENSION 7/20/2003 KHAN, TAUQIR 8/17/1958 PO BOX 420 FAIRTON NJ 08320 SUSPENSION 8/19/2010 KHANDWALA, NITIN RPH 8/24/1951 225 MILLBURN AVENUE MILLBURN NJ 07041 DISQUALIFICATION 10/21/1999 11/29/2012 KHANNA, YASH K. MD 12/28/1941 1093805012 825 BLOOMFIELD AVENUE, VERONA NJ 07044 SUSPENSION 2/22/2012 STE. L1 KHANNA, YASH K. MD 12/28/1941 1093805012 310 CENTRAL AVENUE EAST ORANGE NJ 07018 DISQUALIFICATION 11/30/2014 KHANTHAN, MD 2/26/1942 1003882663 327 SCHUYLER AVENUE KEARNY NJ 07032 DISQUALIFICATION 5/20/2019 SUBRAMANIAM KHAPCHIK, DMITRY VIP CARE 1/18/1978 49 GATES COURT MATAWAN NJ 07747 DISQUALIFICATION 11/10/2019 KHARKOVER, ALEKSANDR PT 2/13/1962 1861594889 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 11/20/2013

KHURANA, NORENDRA 8/15/1944 32 ROLLING HILLS LANE HARRISON NY 10528 DISQUALIFICATION 6/1/1993 KIBALLO, MARIAN B. RN 10/29/1949 4 OJIBWA COURT WARETOWN NJ 08758 SUSPENSION 12/18/2003 KIKTA, DANUTA RN 5/3/1969 593 GREENWICH COURT HIGHTSTOWN NJ 08520 DISQUALIFICATION 2/25/2019 KILLEN, DAWN LPN 8/13/1961 804 COTSWOLD ROAD SOMERDALE NJ 08083 SUSPENSION 9/20/2006 KILLMEYER, LINDA RN 5/12/1955 875 QUAKER CHURCH ROAD PERRYOPOLIS PA 15473 DISQUALIFICATION 12/29/2015

KIM, DOYOUN MD 2/14/1924 545 KEARNY AVENUE KEARNY NJ 07032 SUSPENSION 10/30/1998 KIM, DOYOUN MD 2/14/1924 2302 BAY HEAD DRIVE PARLIN NJ 08859 DISQUALIFICATION 7/13/1999 KIM, JENNIFER J. RPH 10/13/1965 1117 INWOOD TERRACE FORT LEE NJ 07024 DEBARMENT 10/23/2003 KIMBLE, OLLIE SABRINA 6/4/1965 341 OSBOURNE TERRACE, 2C NEWARK NJ 07106 DISQUALIFICATION 2/23/2009

KIMMEL, STEVEN CONTRA 420 DELAWARE STREET MINNEAPOLIS MN 55455 DEBARMENT 4/1/2002 CTS MANAGE R KINDER, EDWARD P. 3/24/1965 5180 LA TERRA AVENUE PAHRUMP NV 89061 DEBARMENT 7/17/2009 7/17/2014 KING, DEBORAH AKA LPN 5/10/1958 9 RADFORD PLACE WILLINGBORO NJ 08046 DISQUALIFICATION 10/18/2001 11/5/2018 BENTON, DEBORAH

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KING, JOHN ANDERSON DO 8/15/1958 11310 S. ORANGE BLOSSOM ORLANDO FL 23837 SUSPENSION 3/20/2007

KING, WILLIAM MD 4/7/1945 1457411670 LEWISBURG USP, BOX 1000 LEWISBURG PA 17837 DISQUALIFICATION 8/20/2010 KINGS PHARMACY 716 MARKET STREET GLOUCESTER NJ 08030 DISQUALIFICATION 12/29/2004 KIRWIN, SHANNON RN 5/19/1973 114 NORTHMONT AVENUE MOUNT EPHRAIM NJ 08059 SUSPENSION 1/18/2007 KISSAM, JEFFREY 6/14/1955 1506 RUSTIC DRIVE OCEAN TOWNSHIP NJ 07712 DISQUALIFICATION 11/28/1992 KLAUMENZER, JANE RN 12/7/1967 8 TENNESSEE AVENUE LONG BEACH NJ 08008 SUSPENSION 4/20/2003 TOWNSHIP KLAUSNER, MARC RPH 10/5/1951 4515 BERGENLINE AVENUE UNION CITY NJ 07087 SUSPENSION 12/29/1999 KLAUSS, GUNNAR MD 12/8/1970 1962685305 30 PROSPECT AVENUE HACKENSACK NJ 07601 DEBARMENT 8/1/2014 6/22/2017 KLEES, DAVID DO 3/1/1957 1527 LINWOOD AVENUE ERIE PA 16510 DISQUALIFICATION 11/20/2015 KLEINMAN, MARSHA PSYCH 4/20/1951 1043332893 32 NORTH 7TH AVENUE HIGHLAND PARK NJ 08904 DISQUALIFICATION 12/4/2012 KLEINMAN, MARVIN AUDIOL 11/15/1950 1609995307 1 CLARIDGE DRIVE, APT. 508 VERONA NJ 07044 DISQUALIFICATION 2/11/2016 OGIST KLEMMONS, IRA DDS 9/6/1948 1841393386 23 DEERPATH LANE COLTS NECK NJ 07722 DISQUALIFICATION 8/7/2017 KLEYMAN, VLADIMIR RPH 4/5/1971 1386957710 3 CATHEDRAL DRIVE LAKEWOOD NJ 08701 DEBARMENT 1/23/2016 KLEYMAN, VLADIMIR RPH 4/5/1971 1386957710 3 CATHEDRAL DRIVE LAKEWOOD NJ 08701 DISQUALIFICATION 5/12/2016 KMET, BOGDAN 5/12/1984 363 EAST ROOSEVELT PHILADELPHIA PA 19120 DISQUALIFICATION 11/20/2015 BOULEVARD KMET, NAZARIY 5/9/1978 2284 SANDTRAP ROAD JAMISON PA 18929 DISQUALIFICATION 11/20/2015 KMET, ROSTISLAV 2/2/1989 13021 BLAKESLEE DRIVE, PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015 APT. A KOBYLECKYJ, CRYSTYNA RN 6/22/1965 35 WOODCOCK MOUNTAIN WASHINGTONVILLE NY 10992 DISQUALIFICATION 9/29/2017 ROAD KOCH, MARK DO 9/9/1959 1528102647 336 BARNES ROAD MONROEVILLE AL 36460 DISQUALIFICATION 11/20/2015 KOGAN, VADIM RN 9/2/1966 56 NORMANDY DRIVE PRINCETON JUNCT NJ 08550 SUSPENSION 12/18/2003 KOHFELDT, LISA RN 3/19/1975 242 WEST FRONT STREET FLORENCE NJ 08518 DEBARMENT 2/7/2019 KOLLMER, W. LANCE MD 6/3/1948 101 OLD SHORT HILLS ROAD WEST ORANGE NJ 07052 DEBARMENT 7/18/2001 DECEASED

KONTOS, DEMETRIUS D. MD 3/27/1935 463 TENAFLY ROAD ENGLEWOOD NJ 07631 SUSPENSION 2/20/2000 KOPLITZ, MARSHALL 1/16/1960 256 NORWOOD AVENUE DEAL NJ 07723 SUSPENSION 12/10/1999 KORNAK, PAUL H. MD 7/11/1951 FCI ELKTON, PO BOX 10 LISBON OH 44432 DISQUALIFICATION 4/19/2007

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KOSLOV, GLEB M. DC 9/30/1958 1366584583 388 RAMAPO VALLEY ROAD OAKLAND NJ 07436 DISQUALIFICATION 12/1/1998

KOSTER, LISA AKA LISA PA 4/20/1970 143737727 10 POSTOL ROAD CREAM RIDGE NJ 08514 DISQUALIFICATION 5/20/2021 HENNESSEY KOTHALANKA, MD 6/14/1950 1184644080 562 SW ROMORA BAY PORT LUCIE FL 34986 DISQUALIFICATION 10/25/2016 SITARAMAKRISHNA KOTTURI, SHIVA MD 2/15/1950 1013168251 512 KEARNY AVENUE, SUITE KEARNY NJ 07032 DISQUALIFICATION 6/17/2018 PERMANENT B KOUSOULIDES, LOUISE RN 4/13/1961 34 TOPANEMUS LANE, APT. FREEHOLD NJ 07728 DISQUALIFICATION 4/20/2009 14 KOUZMA, NATALIA CHHA 2/8/1971 122 CHELSEA WAY BRIDGEWATER NJ 08807 DISQUALIFICATION 2/8/2017 KOVAR, GRACE M. RN 2/18/1956 929 CHELSEA DRIVE BRICKTOWN NJ 08724 SUSPENSION 5/19/2005 KOWNACKY, MEGAN RN 7/9/1986 622 WALDEN WAY LUMBERTON NJ 08048 DISQUALIFICATION 8/28/2017 KOZIUPA, HELENE A. LPN 1/19/1953 64 WESLEYAN DRIVE TRENTON NJ 08690 SUSPENSION 10/20/2002 KRACKE, BARBARA LPN 12/26/1963 44 COVINGTON COURT EAST BRUNSWICK NJ 08816 DEBARMENT 11/13/2018 KRAEMER, LINDA MARIE LPN 9/14/1967 436 SAINT ANDREW PLACE MANALAPAN NJ 07726 SUSPENSION 10/19/2006 KRAKAUER, RANDALL MD 4/25/1949 1588811012 900 W MAIN STREET FREEHOLD NJ 07728 DISQUALIFICATION 2/25/1985 KRAMER JR., EDWARD DC 7/26/1955 1285762401 106 MOTT ROAD BLAIRSTOWN NJ 07825 DISQUALIFICATION 9/28/2017 PERMANENT KRAMER, LARRY S. RPH 1/18/1963 650 PALISADES AVENUE ENGLEWOOD CLIFF NJ 07632 DISQUALIFICATION 1/10/2003 KREISMAN, MARCIA 4/5/1956 8800 BOULEVARD EAST, APT. NORTH BERGEN NJ 07047 SUSPENSION 12/20/2004 6J KRESKI, CHRISTINA RN 5/9/1985 2667 PAXTONVILLE ROAD MIDDLEBURG PA 17842 DISQUALIFICATION 12/29/2015 KRICHEVSKY, RITA MD 4/5/1957 1851561963 4429 DRIFTWOOD DRIVE PHILADELPHIA PA 19129 DISQUALIFICATION 9/20/2017 KRIVOSHIK, MARK MD 2/14/1959 1669409306 16 YEGER DRIVE ALLENTOWN NJ 08501 DISQUALIFICATION 11/20/2015 10/27/2020 KROHN, IVAN T. MD 6/2/1943 1467429258 33 NORTHWOOD DRIVE VINELAND NJ 08360 DEBARMENT 5/20/2012 KROHN, IVAN T. MD 6/2/1943 1467429258 33 NORTHLAND DRIVE VINELAND NJ 08360 DISQUALIFICATION 4/20/2011 KROMAH, ANGIE RN 1/5/1959 3206 LAWNDALE DRIVE EAST GREENSBORO SC 27408 DISQUALIFICATION 5/2/2017

KROWICKI, JENNIFER AKA RN 7/6/1963 232 CLUB DRIVE WALL NJ 07719 SUSPENSION 10/20/2002 GRASSER, JENNIFER KRUTOYARSKY, IRINA 2/23/1954 ALDERSON FPC, GLEN RAY ALDERSON WV 24910 DISQUALIFICATION 12/12/2016 #65107 ROAD, BOX A KUBACKI, JOSEPH MD 4/7/1949 1306834213 PO BOX 3949 PENSACOLA FL 32516 DEBARMENT 5/20/2013

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE KUBLIN, ANNE MD 6/21/1960 182 WHALEPOND ROAD EATONTOWN NJ 07724 SUSPENSION 3/19/2004 KUDLA, ALEXANDER LPN 3/3/1977 1449 LLOYD TERRACE MILLVILLE NJ 08332 DISQUALIFICATION 5/18/2019 KUKASH, ABIGAIL 2/16/1967 6648 WEXFORD AVENUE RICHMOND VA 23255 DISQUALIFICATION 12/1/1998 KUKASH, MAJDI 4/6/1970 87-02 PENNSBURY PLACE RICHMOND VA 23255 DISQUALIFICATION 12/1/1998 KUKREJA, NAV R. MD 1/8/1958 1295739662 1331 COVENTRY COURT ISELIN NJ 08830 DEBARMENT 2/15/2016 KULYK, ODARKA CHHA 10/19/1951 6 COLBY COURT LINCOLN PARK NJ 07035 DISQUALIFICATION 2/8/2017 KUMAR, ANIL 7/1/1945 184 OLD BEEKMAN ROAD MONMOUTH NJ 08852 DISQUALIFICATION 1/14/2005 JUNCTION KUMAR, SAROJ 1/22/1954 184 OLD BEEKMAN ROAD MONMOUTH NJ 08852 DISQUALIFICATION 1/14/2005 JUNCTION KUNZ, BARBARA RN 7/18/1974 55 THIRD STREET NEW YORK NJ 10956 DEBARMENT 8/21/2018 KURAN, BASSEM 10/28/1992 FCI FAIRTON, PO BOX 420 FAIRTON NJ 08320 DISQUALIFICATION 8/7/2017 KURBAN, HAKAN 3/28/1969 41 SIDNEY AVENUE RUTHERFORD NJ 07070 DISQUALIFICATION 6/22/1999 KURIAN, LISSYAMMA RN 9/1/1976 1253 COLLIDGE AVENUE UNION NJ 07083 SUSPENSION 10/20/2002 KURIS, JAY MD 9/14/1944 1003997453 160 MONTDALE DRIVE PRINCETON NJ 08540 DISQUALIFICATION 1/18/2019 KURLANDER-ZAKARIA, RN 3/20/1962 20 ROCK ROYAL ROAD TRENTON NJ 08620 DISQUALIFICATION 2/26/2010 TRACI KURTZ, JOEL P. DMD 10/1/1944 1285874743 9 WESTGATE ROAD LIVINGSTON NJ 07039 SUSPENSION 5/19/2005 KUSHMAN, JOSEPH MD 8/21/1972 1205025541 224 COLONIAL AVENUE UNION NJ 07083 DISQUALIFICATION 6/28/2017 KUSHNER, ALAN DC 10/8/1950 1558398396 SCI GRATERFORD, JG1165, GRATERFORD PA 19426 DISQUALIFICATION 11/20/2015 PO BOX 244 KUYINU, MICHAEL MD 9/28/1947 1235173568 34 VANDERVEER DRIVE BELLE MEAD NJ 08502 DEBARMENT 12/16/2015 KYMER, RHIANNON RN 4/1/1980 8 SPENCER LANE WARREN NJ 07059 DISQUALIFICATION 3/27/2018 LABORDE, JAMES DC 6/3/1955 1578541504 329 SOUTH HIGHLAND DUBOIS PA 15801 DISQUALIFICATION 11/20/2015 STREET LABOY, MICHELLE LPN 9/17/1974 71 LYCEUM COURT STATEN ISLAND NY 10310 DISQUALIFICATION 5/2/2017 11/2/2017 LABRUNA, VINCENT DDS 12/12/1960 1801192216 227 EAST 19TH STREET NEW YORK NY 10003 DISQUALIFICATION 7/22/2002 1/29/2018 LABRUNA, VINCENT DDS 12/12/1960 1801192216 227 EAST 19TH STREET NEW YORK NY 10003 SUSPENSION 9/19/2002 1/29/2018 LACEY, JOAN R. RN 12/4/1947 479 INNES ROAD WOODRIDGE NJ 07075 SUSPENSION 10/19/2000 LACRICCHIO, RICHARD C. 150 ROUTE 150 DENVILLE NJ 07834 DISQUALIFICATION LAFON, MICHAEL MD 1/28/1958 1609168715 107 E. MANTUA AVENUE WENONAH NJ 08090 DISQUALIFICATION 3/28/2004 2/16/2015 LAGRADA, WILLIAM MD 7/6/1960 1316996762 1300 MAIN STREET, STE. 2D CLIFTON NJ 07011 SUSPENSION 2/15/2012 9/25/2014

LAGRADA, WILLIAM MD 7/6/1960 1316996762 15 FORSYTHIA DRIVE EDISON NJ 08837 DEBARMENT 9/25/2014

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LAGUERRE, JEAN RPH 9/19/1968 1 62ND STREET, APT. 4C WEST NEW YORK NJ 07093 DEBARMENT 8/16/2007 LAGUERRE, JEAN RPH 9/19/1968 1 62ND STREET, APT. 4C WEST NEW YORK NJ 07093 DISQUALIFICATION 2/29/2008 LAI, MYUNG-OK RN 9/12/1974 40 PONY LANE FLEMINGTON NJ 08822 DISQUALIFICATION 9/13/2018 6/27/2019 LAIDO, JOSEPH CHHA 8/27/1964 722 SIXTH STREET LYNDHURST NJ 07071 DISQUALIFICATION 2/8/2017 LAJEWSKI, WAYNE MD 1/17/1963 1558364166 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 10/20/2015 LALLEMAND JR., ROGER MD 1/7/1973 1770575821 4 TYCOR COURT HOLMDEL NJ 07733 DISQUALIFICATION 12/20/2014 LAM, MICHAEL CHUNG MD 2/19/1966 1184656050 1625 ANDERSON AVENUE FORT LEE NJ 07024 DEBARMENT 3/6/2014 KAY LAM, MICHAEL CHUNG MD 2/19/1966 1184656050 2 8TH STREET ENGLEWOOD CLIFF NJ 07632 DISQUALIFICATION 11/14/2014 KAY LAMBRIOLA, VINCENT P. DDS 5/1/1956 143 LITTLE FALLS CEDAR GROVE NJ 07009 DISQUALIFICATION 2/20/2001 LAMP, REBECCA RN/CNP 2/14/1963 1568511236 139 DERWOOD DRIVE NEW CUMBERLAND WV 26407 DISQUALIFICATION 11/20/2015 LAMPARELLI, NICHOLAS RPH 11/10/1935 149 SUMMIT AVENUE ISLAND HEIGHTS NJ 08732 DISQUALIFICATION 4/30/2003 LAMPHIER, JENNIFER DMD 7/26/1968 1487860649 38 SILVERSIDE ROAD LAKEWOOD NJ 08701 DISQUALIFICATION 10/23/2019 LAMPROU JR., EMANUEL MD 9/9/1953 1033104526 509 N. BROAD STREET WOODBURY NJ 08096 DEBARMENT 12/18/2012 12/18/2015

LANCE-LANNIGAN, 8/27/1955 12 PROSPECT HILL FLEMINGTON NJ 08822 DISQUALIFICATION 7/23/2010 DECEASED LANDOU, LISSA S. DC 5/1/1959 17B 16TH AVENUE ELMWOOD PARK NJ 07407 SUSPENSION 4/18/2002 LANE, EDWIN MD 1/13/1943 BEACHWOOD NJ 08722 DISQUALIFICATION DECEASED LANG, ANTHONY 12/19/1979 151 SOUTH DURAND PLACE IRVINGTON NJ 07111 DISQUALIFICATION 10/19/2009 10/19/2014

LANG, BRIAN E. LPN 3/2/1965 634 SPROUL STREET CHESTER PA 19013 SUSPENSION 3/20/2006 LANG, DEBRA CHHA 9/1/1958 124 VAN BUSKIRK ROAD TEANECK NJ 07666 SUSPENSION 10/20/2002 LANGERAAP, JOHN MD 7/21/1978 1720299092 198 WHITE LAKE ROAD LAFAYETTE NJ 07848 DISQUALIFICATION 6/26/2018 LANGERAAP, JOHN MD 7/21/1978 1720299092 289 WEST MOUNTAIN ROAD SPARTA NJ 07871 DISQUALIFICATION 9/12/2020

LANGLIEB, MARTIN S. DDS 12/11/1931 94 MIDLAND AVENUE FAIRLAWN NJ 07410 DEBARMENT 8/25/1999 LANNON, JENNIFER RN 4/22/1981 520 COLLINGS AVENUE COLLINGSWOOD NJ 08108 DISQUALIFICATION 6/4/2018 LAPORTE, EDYNE RN/LPN 2/8/1979 1107 FURTH ROAD VALLEY STREAM NY 11581 SUSPENSION 9/27/2007 LASHKEVICH, JOHN P. 11/20/1959 9 CHARLES LANE CHERRY HILL NJ 08003 SUSPENSION 5/8/1998 LASTIVKA, MARTA CHHA 1/11/1958 28 WINDING WOOD, APT. 2- SAYREVILLE NJ 08872 DISQUALIFICATION 2/8/2017 B LASTRA, ABRAHAM 2/12/1970 500 HIGHLAND AVENUE NEWARK NJ 07102 DISQUALIFICATION 4/15/1999 LASTRA, ABRAHAM 2/12/1970 1808 BERGENLINE AVENUE UNION CITY NJ 07087 SUSPENSION 12/20/2010

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LATAWIEC, ANDREA RN 3/7/1964 1681 RARITAN ROAD CLARK NJ 07066 SUSPENSION 5/20/2002 LATCHMAN, BHANWATIE PHARM 4/9/1977 76 WATSON AVENUE EAST ORANGE NJ 07052 DEBARMENT 5/16/2016 TECH LAURIA, SHANNON CHHA 4/7/1974 86 FORT DE FRANCE AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 4/7/2017

LAURITANO, LAURA RN 9/4/1971 47 OLD ORCHARD COURT CEDAR GROVE NJ 07009 DISQUALIFICATION 6/28/2017 8/2/2019 LAVELLE, BARBARA RN/APN 8/28/1958 550 LINCOLN AVENUE RIDGEFIELD NJ 07657 SUSPENSION 12/18/2003 LAVNEVICH, NAUM CHHA 6/21/1967 11 HIAWATHA BOULEVARD OAKLAND NJ 07436 SUSPENSION 11/4/2014 LAVNEVICH, NAUM CHHA 6/21/1967 11 HIAWATHA BOULEVARD OAKLAND NJ 07436 DISQUALIFICATION 2/11/2016 LAZOW, SOLOMON M. MD 6/17/1902 199 MAIN STREET MATAWAN NJ 07747 DISQUALIFICATION 6/1/1993 LEATHERDALE, LAURA CHHA 8/27/1982 4 MEETINGHOUSE ROAD WRIGHTSTOWN NJ 08562 SUSPENSION 9/19/2003 LEBAK, STEPHANIE APN/RN 7/15/1989 1790114965 92 EATON ROAD BORDENTOWN NJ 08505 DISQUALIFICATION 6/29/2019 LEE JR., SAMUEL RPH 8/19/1940 34 PINAFORE LANE WILLINGBORO NJ 08046 DISQUALIFICATION 7/30/1997 LEE, AUGUSTINE MD 10/11/1942 1255478269 905 STUYVESANT AVENUE TRENTON NJ 08618 SUSPENSION 12/22/2011 LEE, AUGUSTINE MD 10/11/1942 1255478269 PO BOX 329002 BROOKLYN NY 11232 DEBARMENT 10/29/2013 LEE, BRIAN LPN 2/13/1968 1722 COPE STREET CAMDEN NJ 08104 SUSPENSION 10/20/2002 8/9/2013 LEE, BRIAN LPN 2/13/1968 1722 COPE STREET CAMDEN NJ 08104 DEBARMENT 7/18/2018 LEE, CHANG HO MD 12/16/1946 1679795181 535A 7TH STREET PALISADES PARK NJ 07650 DISQUALIFICATION 7/20/2015 LEE, DAVID MD 9/24/1957 1275633562 46 CONSTITUTION DRIVE SOUTHAMPTON NJ 08088 DISQUALIFICATION 12/22/2016 PERMANENT LEE, LAURA 1/7/1960 7280 LEMINGTON AVENUE PITTSBURGH PA 15206 DISQUALIFICATION 11/20/2015 LEE, STEVE Y. DDS 2/10/1961 1219 MAIN AVENUE CLIFTON NJ 07111 SUSPENSION 7/19/2001 LEE, SYLVIA S. MD 9/22/1952 1275518490 27 SUNSET PLACE EMERSON NJ 07630 DEBARMENT 8/26/2013 LEEDS, GARY MD 6/27/1953 1316005036 77 WEST 15TH STREET, APT. NEW YORK NY 10011 DEBARMENT 11/21/2016 6-H LEEDS, GARY MD 6/27/1953 1316005036 16 ELIZABETH LANE RIVERSIDE CT 06878 DISQUALIFICATION 5/24/2017 LEIBER, CHARLES 12/29/1938 5804 BOARDWALK, APT. 104 VENTOR NJ 08406 SUSPENSION 5/22/2007

LEIBMAN, JOSEPH B. MD 5/30/1960 PO BOX 1005 PORT JERVIS NY 12771 DEBARMENT 6/22/2000 LEISER, SHAUL RN 5/23/1983 14 HICKORY HILL ROAD JACKSON NJ 08527 DEBARMENT 12/7/2018 6/8/2021 LEKWAUWA, RN 1/1/1967 1643 PARK STREET RAHWAY NJ 07065 DEBARMENT 8/28/2017 6/4/2019 LEON, JACK 6/9/1965 2991 E. CHESTNUT AVENUE, VINELAND NJ 08360 DISQUALIFICATION 2/22/2000 UNIT H80 LEON, JACK 6/9/1965 1071 E. LANDIS AVENUE VINELAND NJ 08360 SUSPENSION 6/29/1998 LEONARD, BARRY A. MD 3/6/1942 15 DARIEN DRIVE CHERRY HILL NJ 08003 DISQUALIFICATION 2/13/1996

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LEONARD, JUDITH RPH 12/10/1958 70 LAUREL DRIVE LITTLE SILVER NJ 07739 SUSPENSION 2/20/2005 LEONARD, TROY COUNSE 12/26/1983 1851691448 999 COLONIAL ROAD FRANKLIN LAKES NJ 07417 DISQUALIFICATION 11/22/2016 PERMANENT LOR LEPKO, ERVIN MD 2/11/1928 18 JANE DRIVE ENGLEWOOD NJ 07632 SUSPENSION 5/20/2002 LERNER, ELIZABETH 8/8/1967 ALDERSON FPC, GLEN RAY ALDERSON WV 24910 SUSPENSION 7/20/2008 ROAD, BOX A LERNER, MARVIN H. MD 9/20/1944 1321 WASHINGTON STREET HOBOKEN NJ 07030 DISQUALIFICATION 3/5/2002

LESLIE, GLENN R. DO 11/19/1954 1285712950 10 FRANKLIN TURNPIKE MAHWAH NJ 07430 SUSPENSION 4/3/2014 11/20/2015 LESLIE, GLENN R. DO 11/19/1954 1285712950 245 WOODLAND AVENUE RAMSEY NJ 07446 DEBARMENT 11/20/2015 LESLIE, GLENN R. DO 11/19/1954 1285712950 FMC - LEXINGTON, PO BOX LEXINGTON KY 40512 DISQUALIFICATION 1/9/2016 14500 LETREN, DENISE CHHA 2/3/1956 916 MADISON AVENUE UNION NJ 07083 DISQUALIFICATION 1/15/2021 LEVELL, CRYSTAL LPN 3/7/1972 143 N. 12TH STREET NEWARK NJ 07107 SUSPENSION 8/20/2001 7/23/2012 LEVIN, HARVEY M. MD 3/19/1935 510 NORTH KINGS HIGHWAY CHERRY HILL NJ 08034 DISQUALIFICATION 6/1/1993

LEVINE, EDWARD J. MD 12/27/1951 7 GREEN HILL ROAD COLTS NECK NJ 07722 SUSPENSION 6/22/1999 7/21/2020 LEVY, EDWARD E. DDS 5/3/1964 108-34 67TH AVENUE FOREST HILLS NY 11375 DEBARMENT 12/29/2011 LEVY, RICHARD S. DPM 1/8/1953 177 MAIN STREET, SUITE 235 FORT LEE NJ 07024 SUSPENSION 12/20/2001

LEWANDOWSKI, DO 9/16/1963 1114070398 100 ATLANTIC AVENUE CAMDEN NJ 08101 DEBARMENT 8/28/2014 KENNETH LEWANDOWSKI, DO 9/16/1963 1114070398 24 PEACH BLOSSOM LANE MIDDLETOWN NJ 07748 DISQUALIFICATION 11/20/2015 KENNETH LEWANDOWSKI, DO 9/16/1963 1114070398 24 PEACH BLOSSOM LANE MIDDLETOWN NJ 07748 DEBARMENT 6/30/2016 PERMANENT KENNETH LEWIN, TASHEIKA CHHA 12/13/1990 139 B 14TH AVENUE ELMWOOD PARK NJ 07407 DISQUALIFICATION 7/14/2017 8/21/2018 LEWIS, ERICA CHHA 1/13/1989 1098 PENNSYLVANIA FRANKLINVILLE NJ 08322 DISQUALIFICATION 1/29/2018 AVENUE LEWIS, TOLIA CHHA 2/6/1990 391 ISABELLA AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 9/19/2017 LEYBA, ROGELIO 3/1/1973 24 WEBSTER STREET NEWARK NJ 07104 DISQUALIFICATION 2/11/2016 LEYSON, JOSE MD 8/17/1946 1528169539 6 RANNEY ROAD LONG VALLEY NJ 07853 DISQUALIFICATION 10/3/2019 LEYSON, JOSE MD 8/17/1946 1528169539 6 RANNEY ROAD LONG VALLEY NJ 07853 DISQUALIFICATION 6/30/2018 PERMANENT

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LI, STAN MD 2/10/1954 1386631794 16 SECRETARIO WAY HAMILTON NJ 08690 DISQUALIFICATION 8/20/2015 PERMANENT LI, STAN MD 2/10/1954 1386631794 16 SECRETARIO WAY HAMILTON NJ 08690 DISQUALIFICATION 11/18/2015 PERMANENT LIBRIZZI, MICHELLE H. LPN 3/25/1961 5 BELLIS COURT RINGOES NJ 08551 DISQUALIFICATION 7/18/2001 LICKFIELD, KEVIN J. DO 1/19/1962 524 JUSTICE DRIVE MARLTON NJ 08053 DISQUALIFICATION 3/3/2003 LIEBOWITZ, LEONARD J. MD 10/26/1949 5 POE COURT MORGANVILLE NJ 07741 DEBARMENT 8/18/2001 LIFE CARE HOME 1972641496 2127 NORTH 6TH STREET PHILADELPHIA PA 19122 DISQUALIFICATION 12/29/2015 SERVICES OF NORTHWESTERN PENNSYLVANIA DBA GREAT LAKES HOME LIFE SUPPORT 1659699049 CI MOSHANNON VALLEY, 555 PHILLIPSBURG PA 16866 DISQUALIFICATION 12/29/2015 CORPORATION GEO DRIVE LILLO, CHRISTOPHER T. DMD 10/1/1967 1720150675 191 HIGHWAY 37 WEST TOMS RIVER NJ 08755 DISQUALIFICATION 12/20/2012 LIMIDO, GLEN CARL RPH 11/7/1940 1 EAST PLEASANT AVENUE MAYWOOD NJ 07607 SUSPENSION 10/19/2006 LIMONGELLI, WILLIAM DDS 12/27/1943 1184796534 679 SO. ORANGE AVENUE NEWARK NJ 07106 DISQUALIFICATION 10/30/1986 LINDER, NORBERT MD 4711 BERGENLINE AVENUE UNION CITY NJ 07087 DISQUALIFICATION 3/23/1977 LINK, TIMOTHY MD 10/2/1972 1477767705 63 MONMOUTH PARKWAY MONMOUTH BEACH NJ 07750 DISQUALIFICATION 2/5/2018 LIPMAN, CLIFFORD R. MD 1/6/1951 1083676670 26 UNION AVENUE FREEHOLD NJ 07728 DEBARMENT 1/16/2015 5/30/2018 LIPPIELLO, JENNIE A. DC 6/29/1955 1366605966 2920 ROUTE 23 SOUTH NEWFOUNDLAND NJ 07435 SUSPENSION 4/19/2001 LIPSON, PHILIP A. DO 4/21/1950 38 W. NORTON DRIVE SOUTHAMPTON PA 18966 DISQUALIFICATION 10/19/2005 LIRIANO, ANGELA CHHA 1/4/1959 79 CLINTON AVENUE, APT #2 JERSEY CITY NJ 07306 DISQUALIFICATION 11/22/2017 PERMANENT

LIRIANO, ANGELA CHHA 1/4/1959 79 CLINTON AVENUE, APT #2 JERSEY CITY NJ 07306 DISQUALIFICATION 7/14/2017

LIRIANO, ANGELA CHHA 1/4/1959 79 CLINTON AVENUE, APT #2 JERSEY CITY NJ 07306 DISQUALIFICATION 4/19/2018

LIVSHITS, BORIS 12/14/1969 1935 83RD STREET APT. E6 BROOKLYN NY 11214 DISQUALIFICATION 8/1/2009 LIVSHITZ PHARMACY INC. 203 16TH AVENUE NEWARK NJ 07103 DISQUALIFICATION 5/21/1980 LIZIK, MICHELLE LPN 1/10/1970 451 FULLERTON AVENUE CAMBRIDGE SPRINGS PA 16403 DISQUALIFICATION 11/20/2015

LLANOS, LATOYA CHHA 8/15/1977 433 W. QUINCE STREET VINELAND NJ 08360 DEBARMENT 3/29/2002 LOAIZA, ERIKA CHHA 5/2/1991 206 COVENTRY LANE SOMERSET NJ 08873 DISQUALIFICATION 2/8/2017 LOBO, ANGEL R. MD 12/4/1932 661 14TH AVENUE PATERSON NJ 07504 DEBARMENT 6/11/2002

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LOBO, ANGEL R. MD 12/4/1932 398 STEWART AVENUE GARDEN CITY NY 11530 SUSPENSION 5/20/2007 LOBO, MERCY 11/1/1941 22 HELEN PLACE CLIFTON NJ 07011 DISQUALIFICATION 4/23/2007 LOCK, ABRAHAM J. MD 9/5/1941 1801 AVENUE J BROOKLYN NY 12230 DEBARMENT 2/25/2001 LOCURATOLO, LUIS R. MD 12/15/1929 104-01 ROOSEVELT AVENUE CORONA NY 11368 SUSPENSION 12/1/1995

LOGAN, JEANETTE E. RN 9/5/1953 12 ARAGON COURT TRENTON NJ 08628 SUSPENSION 5/20/2004 LOLL-VAN SICKLE, RN 9/27/1953 416 SALEM STREET ELMER NJ 08318 SUSPENSION 4/20/2000 LOPEZ, JOHN J. 3/28/1967 428 N 16TH STREET KENILWORTH NJ 07033 DEBARMENT 12/11/2001 LOPEZ, JOSE A. MD 8/28/1962 24 WOODLAND ROAD BLOOMFIELD NJ 07003 SUSPENSION 11/20/2006 LOPEZ, JULIANA CHHA 7/8/1987 236 GRAND AVENUE CAMDEN NJ 08105 DISQUALIFICATION 2/8/2017 LOPEZ-FALCONE, JUAN 8/23/1954 8385 SW 43RD STREET MIAMI FL 33155 DISQUALIFICATION 5/2/2003 LOPRESTI, JACQUELINE A. DO 12/30/1960 1043348220 568 RIDGE ROAD FAIR HAVEN NJ 07704 SUSPENSION 12/20/2011 LOPRESTI, JACQUELINE A. DO 12/30/1960 1043348220 ALDERSON FPC, GLEN RAY ALDERSON WV 24910 DISQUALIFICATION 3/20/2014 ROAD., BOX A LOTTERMAN, RANDEE RN 7/10/1985 6 JUNIATA STREET WEST MILFORD NJ 07480 DISQUALIFICATION 6/15/2017 LOUIS-BAPTISTE, CHHA 5/2/1979 51 LINCOLN STREET EAST ORANGE NJ 07017 DISQUALIFICATION 10/20/2017 GUERLINE LOUISSAINT, PARACLET MD 7/8/1948 1164519179 669 ELIZABETH AVENUE NEWARK NJ 07112 DEBARMENT 1/1/2001 1/11/2017 LOUKHNATI, RAJAA CHHA 10/12/1973 5 COLGATE DRIVE CHERRY HILL NJ 08034 DEBARMENT 2/20/2017 LOVETT, BETTIE CHHA 10/17/1950 212 SENACA TRAIL BROWNS MILLS NJ 08064 DEBARMENT 5/28/2013 LOWELL-SENTURIA, LISA MD 4/2/1967 DOGWOOD TRAIL RANDOLPH NJ 07869 SUSPENSION 11/20/2008 AKA DIETRICH, LISA B. LOWREY, RODNEY 2/13/1945 88 3RD AVENUE ATLANTIC HIGHLANDS NJ 07716 DISQUALIFICATION LUCA, BONNIE J. 9/15/1962 1016 WASHINGTON WASHINGTON NJ 07882 DEBARMENT 6/10/2007 GARDENS LUCAS, KATINA RN 4/29/1960 126 LAGUARDIA AVENUE STATEN ISLAND NY 10314 SUSPENSION 10/19/2006 LUDDEN, JAMES W. DPM 2/5/1963 1720054935 23 SOCIETY HILL WAY TINTON FALLS NJ 07724 DISQUALIFICATION 6/8/2007 LUDDEN, JAMES W. DPM 2/5/1963 1720054935 23 SOCIETY HILL WAY TINTON FALLS NJ 07724 DISQUALIFICATION 12/19/2016 LUDWICK, DONNA RN 7/4/1966 7 DEER VALLEY LANE, UNIT VERNON NJ 07462 DISQUALIFICATION 6/22/2019 12 LUDWIKOWSKI, MICHAEL RPH 2/18/1972 113 DIXONTOWN ROAD MEDFORD NJ 08055 DISQUALIFICATION 4/13/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE LUDWIKOWSKI, MICHAEL RPH 2/18/1972 FCI LORETTO, PO BOX 1000 CRESSON PA 16630 DISQUALIFICATION 5/14/2021

LUNDY, HOWARD 4/26/1955 1 MALKE DRIVE OCEAN NJ 07712 DEBARMENT 4/4/2015 LYNCH, CHRISTOPHER MD 1/25/1950 1407813975 1719 PENN CROSSING ALLENTOWN PA 18104 DISQUALIFICATION 11/20/2015 LYNCH, KATHRYN LPN 7/30/1968 33 STEVENS TERRACE SOUTH PLAINFIELD NJ 07080 DISQUALIFICATION 2/7/2019 LYONS, DANA LPN 4/29/1963 245 4TH AVENUE ROEBLING NJ 08554 SUSPENSION 2/20/2002 LYONS-VALENTI, ASHLEY APN/RN 12/7/1956 1275715179 119 PALMER PLACE SWEDESBORO NJ 08085 DISQUALIFICATION 10/4/2020 PERMANENT LYVAN, KIM DDS 9/19/1955 1346458965 199 CANAL STREET, #201 NEW YORK NY 10013 SUSPENSION 11/27/2000 M & G LIVERY CO., INC. 6 PLEASANT VALLEY WAY WEST ORANGE NJ 08052 SUSPENSION 6/19/2003 M & G TRANSPORTATION 269 SHEFFIELD STREET MOUNTAINSIDE NJ 07092 DEBARMENT 10/31/2002 AND LIVERY

M & M MEDICAL LIVERY 64 BEVAN STREET JERSEY CITY NJ 07306 DISQUALIFICATION 5/31/1994 MAAT, THOMAS P. LPN 10/17/1969 2311 4TH AVENUE TOMS RIVER NJ 08753 SUSPENSION 3/18/2004 MACH, PHILIP C. MD 9/26/1957 1770562993 PO BOX 1000 LORETTO PA 15940 SUSPENSION 5/9/2008 MACH, PHILIP C. MD 9/26/1957 1770562993 30 DANIEL DRIVE FRANKLIN PARK NJ 08823 DISQUALIFICATION 10/7/2008 MACH, PHILIP C. MD 9/26/1957 1770562993 17 SHELDON ROAD PEMBERTON NJ 08068 DISQUALIFICATION 10/30/2018 PERMANENT MACIAS, ERICK DC 5/5/1985 1215311329 111 E. DEWEY AVENUE, APT. WHARTON NJ 07885 DISQUALIFICATION 7/24/2020 254 MADDOX, CALISA CHHA 5/12/1977 42 TRITON TERRACE NEWARK NJ 07104 DISQUALIFICATION 9/20/2019 MADDOX, PEARL V. CHHA 9/8/1968 KINSLEY ROAD PEMBERTON NJ 08068 DISQUALIFICATION 9/25/2007 MAHAJAN, SHYAM S. MD 3/18/1945 1144496449 7624-A BRISLIN ROAD, #7 STROUDSBURG PA 18360 DISQUALIFICATION 12/1/1998 MAHARAJ, GANGARAM RPH 11/23/1957 1326323106 72 VAN REIPEN AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 7/22/2017 MAHER, PATRICIA RN 10/25/1958 26 PROSPECT STREET RAMSEY NJ 07446 DISQUALIFICATION 2/7/2019 MAHGOUB, ADAM 1/1/1961 1995 JFK BOULEVARD, #14 JERSEY CITY NJ 07305 DISQUALIFICATION 6/17/2002 MAHMOOD, SHAHID 4/3/1960 228 GRAND STREET JERSEY CITY NJ 07302 DEBARMENT 3/30/2010 MAHMUD, ASIF MD 2/17/1967 2024 W. 13TH STREET BROOKLYN NY 11223 SUSPENSION 3/18/2004 MAIGUE, LLEWELYN RN 11/30/1960 6 CRYSTAL AVENUE WEST ORANGE NJ 07052 SUSPENSION 4/19/2001 MAIN PHARMACY, LLC 1861705873 80 SOUTH MAIN ROAD, VINELAND NJ 08360 DISQUALIFICATION 4/13/2018 SUITE 112 MAIORANO, JOHN RPH 2/13/1951 1659492940 345 UNION HILL ROAD ENGLISHTOWN NJ 07726 DISQUALIFICATION 7/11/2000 MAIORANO, JOHN RPH 2/13/1951 1659492940 123 EAST END AVENUE ISLAND HEIGHTS NJ 08732 SUSPENSION 4/18/2002 MAIS, JENNIFER C. PA 12/1/1964 1801035084 22 NEW STREET HILLSDALE NJ 07642 DISQUALIFICATION 4/30/2015 MAKKER, RAM S. MD 4/13/1950 1538117213 52 SNAPDRAGON LANE ROSLYN HEIGHTS NY 11577 DISQUALIFICATION 4/20/2010

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MALADY, SUSAN AKA RN 3/31/1949 PO BOX 468 BLAIRSTOWN NJ 07825 SUSPENSION 6/20/2001 MAWHINNEY-BRIGNOLA, SUSAN MALAMUD, YAFIM 2/4/1942 177 SARGEANT AVENUE CLIFTON NJ 07013 DEBARMENT 8/8/2003 MALDONADO, CHEYENNE PHARM 9/22/1991 3 DUKE DRIVE TOMS RIVER NJ 08757 DEBARMENT 1/5/2017 TECH MALDONADO, SANDRA CHHA 5/9/1970 2808 CONGRESS ROAD CAMDEN NJ 08104 DISQUALIFICATION 3/6/2018 MALDONADO, TOSHIRA CHHA 1/11/1980 4648 THELMA AVENUE MAYS LANDING NJ 08330 DEBARMENT 1/20/2017 MALIK, ATIF MD 10/27/1969 FCI LORETTO, PO BOX 1000 LORETTO PA 15940 DISQUALIFICATION 3/1/2019

MALIK, MOHAMMAD S. 5/15/1960 146 OLD COURTHOUSE MANHASSETT NY 11400 SUSPENSION 9/22/2000 ROAD MALIK, MOHAMMAD S. 5/15/1960 146 OLD COURTHOUSE MANHASSETT NY 11040 SUSPENSION 10/20/2002 ROAD MALLOY, TIFFANY APN/RN 9/30/1970 1790910503 34 VIBURNUM COURT LAWRENCEVILLE NJ 08648 DEBARMENT 8/28/2017 MALLOZZI, DEBORAH RN 9/9/1964 1603 PERSHING AVENUE FORKED RIVER NJ 08731 DISQUALIFICATION 6/28/2017 MANALO, JERICHO RN 6/30/1989 22 PINE STREET BLOOMFIELD NJ 07109 DISQUALIFICATION 11/13/2017 MANCILLA, MARIA CHHA 4/24/1956 284 REDMOND STREET NEW BRUNSWICK NJ 08873 SUSPENSION 5/14/2007 MANCINI, ANGELO D. RPH 8/1/1950 SKEET & DIXONTOWN ROAD MEDFORD NJ 08055 DISQUALIFICATION 7/1/1985

MANFORD, ROSE AKA CHHA 10/1/1984 5507 WARNER VIEW LANE WESTVILLE OH 43081 DEBARMENT 7/13/2018 ACQUAH, ROSE MANFRE, MARIA LPN 9/26/1986 262 N. MIDDLESEX COURT THOROFARE NJ 08086 DISQUALIFICATION 6/5/2017 MANGIONE, MICHELE RN 10/24/1954 35 LONGVIEW DRIVE WALDWICK NJ 07363 SUSPENSION 9/20/2004 MANIN, LAWRENCE 611 BURLINGTON MOUNT HOLLY NJ 08060 DISQUALIFICATION 4/12/1993 MANION, WILLIAM MD 8/12/1952 1134120801 33 MEADOW DRIVE WOODSTOWN NJ 08098 DISQUALIFICATION 3/8/2018 MANJO, EUNICE AKA RN 7/4/2969 128 FIELDBROOK DRIVE MAGNOLIA DE 19962 DISQUALIFICATION 10/3/2019 GUANMESIA, EUNICE MANKOFF, BERNARD GREEN GROVE ROAD NEPTUNE NJ 07753 DISQUALIFICATION MANNAVA, VENKATA RPH 10/18/1969 1356478895 3300 EAST WEST HIGHWAY HYATTSVILLE MD 20782 DISQUALIFICATION 6/30/2016 SRINIVAS MANNING, LUTHER 3/21/1955 586 WEST SCOTT AVENUE RAHWAY NJ 07065 SUSPENSION 10/20/2008 MANNO, MICHAEL DC 5/14/1969 1356704738 PO BOX 1000 FORT DIX NJ 08640 SUSPENSION 10/20/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MANSOUR, ALI MD 3/17/1968 1346225885 225 DEMOTT LANE SOMERSET NJ 08873 DEBARMENT 12/20/2014 10/25/2019 MANZE, PATRICK MD 7/28/1946 53 GARDNER AVENUE CHATHAM NJ 07928 SUSPENSION 2/20/2005 DECEASED MANZELLA, JOHN DO 7/15/1964 680 BROADWAY AVENUE PATERSON NJ 07514 DEBARMENT 6/28/2014 MANZI, JOHN J RPH 6 TEMPLE ROAD, APT 22 C VINELAND NJ 08360 DISQUALIFICATION 6/1/1993 MANZONI, JANET M. DC 4/27/1955 1851497168 52 TENNET ROAD MORGANVILLE NJ 07751 SUSPENSION 2/3/1998 MANZONI, JANET M. DC 4/27/1955 1851497168 9 KILMER DRIVE MANALAPAN NJ 07726 DISQUALIFICATION 5/20/2009 MARC, DAMILOLA LPN 11/26/1986 165 FULTON AVENUE, APT. 3 JERSEY CITY NJ 07305 DISQUALIFICATION 11/23/2019

MARCELL, JOSEPH A. 12/15/1928 305 MAIN STREET RIDGEFIELD PARK NJ 07660 DISQUALIFICATION DECEASED MARCHAND, ANTHONY MD 11/4/1944 19 DEXTER DRIVE NORTH BASKING RIDGE NJ 07920 SUSPENSION 9/19/2003 MARCHETTA, LEONARD PA 12/5/1966 1720196140 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 6/3/2016 MARCOS, FRANCISCO RPH 12/10/1975 1699158063 777 CHARNWOOD DRIVE WYCKOFF NJ 07481 DISQUALIFICATION 9/20/2011 4/5/2017 MARCUS, ALAN L. DC 11/22/1951 789 CLIFTON AVENUE CLIFTON NJ 07013 DISQUALIFICATION 7/25/2001 MARKOFF, MORTON DO 10/9/1940 908 FRANCINE DRIVE CHERRY HILL NJ 08003 SUSPENSION 11/7/1997 DECEASED MARKOSOVA, GRETA CHHA 1/3/1961 2301 WESTMINSTER PARLIN NJ 08859 DISQUALIFICATION 1/31/2017 BOULEVARD MARON, ANDREW DDS 6/12/1961 1215035134 326 BROAD STREET RED BANK NJ 07011 DISQUALIFICATION 10/21/2015 MARON, ANDREW DDS 6/12/1961 1215035134 16041 LOCH KATRINE TRAIL, LAKE WORTH FL 33467 DISQUALIFICATION 11/1/2019 APT. 7501 MARONPOT, BARBARA DDS 12/20/1953 1821203696 281 MENDHAM ROAD BERNARDSVILLE NJ 07924 DEBARMENT 3/17/2015 MARQUEZ, MANUEL S. MD 6/5/1925 112 DOWNING COURT MOUNT LAUREL NJ 08054 DISQUALIFICATION 12/5/1997 DECEASED MARQUEZ, OLGA COUNSE 2827 LINCOLN AVENUE CAMDEN NJ 08105 SUSPENSION 4/29/2003 LOR MARRAZZO-TALLIA, RPH 1/3/1955 406 HARDING ROAD FAIRHAVEN NJ 07704 SUSPENSION 10/19/2006 CHRISTAL MARSON-FRANCIS, CHHA 9/16/1993 7810 CORBETT ROAD PENNSAUKEN NJ 08109 DISQUALIFICATION 4/18/2017 JAVON MARTIN, ANDRE E. COUNSE 12/6/1972 127 N. DERBY AVENUE VENTNOR NJ 08406 DEBARMENT 5/24/1999 LOR MARTIN, BENNIE M. COUNSE 12/19/1964 476 CLIFTON AVENUE CLIFTON NJ 07011 SUSPENSION 5/15/2003 LOR MARTIN, ELLIOTT DPM 9/19/1936 5 HOLLIS ROAD EAST BRUNSWICK NJ 08816 DISQUALIFICATION 4/22/1991 DECEASED

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MARTIN, MARGARET LPN 1/15/1959 207 HEGGEN AVENUE EGG HARBOR NJ 08234 DISQUALIFICATION 9/8/2017 PERMANENT TOWNSHIP MARTIN, PATRICK 11/17/1959 51 HENRY STREET SUCCASUNNA NJ 07876 DISQUALIFICATION 11/20/2015 MARTIN, SUSAN C. LPN/RN 7/8/1961 3421 BRIGHTON STREET PHILADELPHIA PA 19149 SUSPENSION 9/20/2005 MARTINEZ, CINTYA CHHA 8/17/1982 61 CONCORD STREET, APT. JERSEY CITY NJ 07306 DISQUALIFICATION 2/20/2017 3A MARTINEZ, ELIEZER COUNSE 11/25/1947 215 SOUTH BURLINGTON BRIDGETON NJ 08302 SUSPENSION 2/20/2006 LOR ROAD MARTINEZ, NATASHA CHHA 11/6/1991 87 N. 7TH STREET, APT. 1 PATERSON NJ 07522 DISQUALIFICATION 9/26/2018 MARTINEZ, RENATO F. MD 9/1/1948 199 BROAD STREET, SUITE 1- BLOOMFIELD NJ 07003 SUSPENSION 8/5/1997 MARTINEZ, SUZETTE CHHA 12/26/1966 52 FOREST GLEN DRIVE HIGHLAND PARK NJ 08904 DISQUALIFICATION 7/31/2017 MARTINIQUE, BURTON OD 3/27/1935 1942370945 2 SHEFFIELD DRIVE WILLINGBORO NJ 08046 DEBARMENT 4/18/2016 MARTIROSOV, DO 8/19/1963 1700931185 1084 BRIAR WAY FORT LEE NJ 07024 DISQUALIFICATION 11/20/2017 5/30/2018 ALEKSANDR MARTORANO, JOSEPH RPH 8/13/1935 1248 STANWOOD STREET PHILADELPHIA PA 19100 DISQUALIFICATION 6/1/1993 MARUCCI, DONATO MD 11/14/1955 14 FRANKLIN STREET BELLEVILLE NJ 07109 DISQUALIFICATION 9/28/1999 MARURI, NAGESWARA RPH 3/20/1952 1083932495 8 REDWOOD AVENUE WEST ORANGE NJ 07052 DISQUALIFICATION 2/11/2016 REDDY MASCOLO, JOSEPHINE RN 6/4/1949 1814 KENNEDY BOULEVARD UNION CITY NJ 07087 DEBARMENT 4/7/2004

MASHALI, FATHALLA MD 11/19/1954 1386609907 FMC DEVENS #96065-038, AYER MA 01432 DISQUALIFICATION 8/20/2018 PO BOX 879 MASI, JAMES COUNSE 10/4/1947 1518046226 631 OCEAN AVENUE, BRADLEY BEACH NJ 07720 DEBARMENT 2/20/2013 LOR APT.304 MASON, JAMES I. 8/7/1926 702 SUNSHINE LAKES DRIVE VOORHEES NJ 08043 SUSPENSION 2/23/2000

MASON, SYDELLE 9/19/1942 702 SUNSHINE LAKES DRIVE VOORHEES NJ 08043 SUSPENSION 2/23/2000

MASOOD, MARUK 3/14/1968 1 CHESTERFIELD DRIVE WARREN NJ 07059 DISQUALIFICATION 11/20/2012 MASOOD, YOUSUF MD 4/19/1964 1235343138 PO BOX 8000 BRADFORD PA 16701 DISQUALIFICATION 11/20/2012 MASRI, NASSER M. 2/1/1966 360 GETTY AVENUE PATERSON NJ 07503 SUSPENSION 10/19/2000 2/15/2019 MASSARO, DONNA M. AUDIOL 11/24/1959 205 RIVA DRIVE, APT. 24 HACKETTSTOWN NJ 07840 SUSPENSION 11/20/2008 OGIST

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MASTRANGELO, MARTHA LPN 12 NORTH 28TH AVENUE LONGPORT NJ 08403 DISQUALIFICATION 6/1/1993

MASTRIA, ERNEST PSYCH 12/6/1947 213 9TH AVENUE BELMAR NJ 07719 DISQUALIFICATION 8/18/2011 MASTROKOSTAS, RPH 1/29/1973 1861769481 11 EQUINOX LANE FREEHOLD NJ 07728 DISQUALIFICATION 10/15/2009 2/15/2019 ANTHANASIOS MATALON, VIVIENNE MD 4/19/1956 1396858635 1 NORTH SYRACUSE DRIVE CHERRY HILL NJ 08034 DISQUALIFICATION 12/19/2016 MATALON, VIVIENNE MD 4/19/1956 1396858635 1 NORTH SYRACUSE DRIVE CHERRY HILL NJ 08034 DEBARMENT 10/31/2016 MATHEW, REX MD 8/27/1975 1336164862 2301 SOUTH BROAD STREET PHILADELPHIA PA 19148 DISQUALIFICATION 1/2/2017

MATHEW, REX MD 8/27/1975 1336164862 17608 PRINCE EDWARD OLNEY MD 20832 DISQUALIFICATION 4/4/2018 DRIVE MATRISS, JOSEPH P. DDS 7/3/1923 1700013554 337 HENRY STREET HASBROUCK HEIGHTS NJ 07604 SUSPENSION 9/18/2003

MATRISS, JOSEPH P. DDS 7/3/1923 1700013554 337 HENRY STREET HASBROUCK HEIGHTS NJ 07604 DEBARMENT 10/9/2007

MATTERN, JILL MD 3/12/1961 1669514253 20 WILSON TERRACE, APT. 1 STATEN ISLAND NY 10304 DEBARMENT 11/29/2015 MATTHEWS, BHA'SHEER CHHA 6/24/1994 16 HEMLOCK WALK CAMDEN NJ 08104 DISQUALIFICATION 4/18/2017 MATURA, DENISE RN 9/27/1969 1001 LINDEN AVENUE BRICK NJ 08723 SUSPENSION 10/26/1999 7/20/2012 MATURA, WILLIAM DC 11/7/1943 PO BOX 7000 FORT DIX NJ 08640 SUSPENSION 12/20/2006 MATZ, RODNEY S. MD 2/6/1942 43 MACDONALD DRIVE WAYNE NJ 07470 DISQUALIFICATION 12/29/1995 MAUGLE, BARBARA DPM 7/30/1963 800 HILLSIDE AVENUE WESTFIELD NJ 08901 DISQUALIFICATION 1/10/2001 MAUIRI, SANDY LPN 6/20/1958 34 FRANKLIN PLACE TOTOWA NJ 07512 SUSPENSION 6/20/2005 MAWHINNEY-BRIGNOLA, RN 3/31/1949 PO BOX 468 BLAIRSTOWN NJ 07825 SUSPENSION 6/20/2001 SUSAN AKA MALADY, SUSAN MAXVITAT, KATHLEEN E. PHARM 5/8/1986 200 W. MERCHANTS STREET AUDUBON NJ 08106 SUSPENSION 4/20/2011 TECH MAXYMIV, NICOLAI 3/13/1971 3 PARKWOOD DRIVE SOUTH AMBOY NJ 08879 DISQUALIFICATION 7/10/2003 MAYER, FREDERICK G. DC 6/17/1953 1811082894 610 WOODLAND AVENUE AVON BY THE SEA NJ 07717 DISQUALIFICATION 8/20/2000 9/21/2011 MAYS, CYNTRICE CHHA 7/11/1984 98 OAK STREET CLEMENTON NJ 08021 DISQUALIFICATION 9/19/2017 MAYS, ROBERT E. 6/26/1977 6133 HANLON STREET CAPITAL HEIGHTS MD 20743 DISQUALIFICATION 10/31/2017 MAZUR, BONNIE DMD 1/21/1961 210 E. SEAVIEW AVENUE LINWOOD NJ 08221 SUSPENSION 1/27/1998

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MAZZACCOS PHARMACY 427 PROSPECT STREET LONG BRANCH NJ DISQUALIFICATION 7/27/1983 INC. MCAFEE, JORDAN CHHA 7/24/1987 13 FAIRWAY COURT MARLTON NJ 08053 DISQUALIFICATION 7/20/2017 MCAULAY-LEVESQUE, LPN 12/9/1954 141 BRUNSWICK AVENUE BLOOMSBURY NJ 08804 DISQUALIFICATION 4/27/2019 PERMANENT BARBARA MCCABE, LAUREN AKA RN 4/10/1982 9 FIELDCREST WAY HAZLET NJ 07730 DISQUALIFICATION 12/30/2019 BARSH, LAUREN MCCABE, VALERIE A. LPN 1/21/1964 830 CHESTNUT STREET KEARNY NJ 07032 SUSPENSION 9/20/2004 MCCAFFERTY, ASHLEY RN 8/2/1991 245 ATLANTIC AVENUE, APT. LONG BRANCH NJ 07740 DISQUALIFICATION 1/29/2019 115 MCCAGG, CAROLINE MD 1/4/1940 1346261849 1415 MARTINE AVENUE PLAINFIELD NJ 07060 DISQUALIFICATION 4/18/2019 PERMANENT MCCALL, ELDORA CHHA 1/7/1965 OLD CRANBURY ROAD CRANBURY NJ 08512 SUSPENSION 9/20/2007 MCCANN, DAVID 5/14/1968 16 LAFAYETTE PLACE LYNDHURST NJ 07071 DISQUALIFICATION 10/3/2019 MCCARVILLE, MICHAEL MD 8/21/1956 1871666321 1020 IRVING AVENUE ENDICOTT NY 13760 DISQUALIFICATION 11/20/2015 MCCASKILL, CAMMY 11/3/1970 6518 BOBOLINK PLACE PHILADELPHIA PA 19142 DISQUALIFICATION 11/20/2015 MCCASKILL, JACQUELINE CHHA 6/20/1963 34 36 12TH AVENUE PATERSON NJ 07524 DISQUALIFICATION 10/15/2004

MCCOLGAN, PETER DMD 3/30/1946 RR 1, PO BOX 29 TANNERSVILLE PA 18372 SUSPENSION 6/19/2001 MCCOLGAN, PETER DMD 3/30/1946 35 OLD WOLFE ROAD BUDD LAKE NJ 07828 DEBARMENT 5/13/1999 MCCREA, NIOME CHHA 1/11/1989 63 VILLAGE DRIVE BARNEGAT NJ 08005 DISQUALIFICATION 9/26/2017 MCDANIELS, HOLLY RN 1/4/1988 111 COUNTRYSIDE DRIVE MYRTLE BEACH SC 29579 DISQUALIFICATION 6/28/2017 MCDONALD, JOSEPH MD 8/17/1933 2052 MORRIS AVENUE UNION NJ 07083 DEBARMENT 9/21/1999 MCDONALD, KEITH THERAPI 7/7/1954 2220 MEADOW LANE, SECAUCUS NJ 07094 DISQUALIFICATION 2/20/2001 ST APT.D26 MCDONALD, RHONDA RN 8/20/1970 962 GROVE STREET IRVINGTON NJ 07111 SUSPENSION 1/18/2007 MCDONALD-HASWELL, 6/10/1955 52 ELM STREET MONTCLAIR NJ 07042 SUSPENSION 4/18/2002 EVERSLEY MCDOWELL, SHASHAWN CHHA 5/25/1994 25 WILLIAM STREET, 2ND FL LITTLE FALLS NJ 07424 DEBARMENT 12/6/2017

MCELROY, DONALD J. DDS 9/14/1923 14 RESERVOIR AVENUE DOVER NJ 07801 DISQUALIFICATION 2/20/1983 MCFADDEN, TIKEYA CHHA 2/13/1991 526 RAND STREET CAMDEN NJ 08105 DISQUALIFICATION 2/8/2017 MCGAVIN, CAMERON PSYCH 11/9/1969 1760408041 417 BOYD STREET TURTLE CREEK PA 15145 DISQUALIFICATION 3/27/2015 MCGEE, ELIZABETH RN 8/25/1957 51 VAN DUYNE AVENUE WAYNE NJ 07470 SUSPENSION 2/20/2002

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MCGEE, JOHN MD 5/8/1958 1811991284 1160 KENNEDY BOULEVARD BAYONNE NJ 07002 DEBARMENT 9/6/2016

MCGILL, WINSTON MD 4/4/1947 1093810749 258 CENTRAL AVENUE ORANGE NJ 07050 DEBARMENT 10/16/2014 MCGINNIS, GEORGE J. 119 ADELINE STREET TRENTON NJ 08611 DISQUALIFICATION 10/16/1986 MCGINTY, JAMIE RN 5/9/1978 251 DEVON ROAD TOWNSHIP OF NJ 07676 DISQUALIFICATION 7/22/2017 WASHINGTON MCGLONE, CARLA RN 6/21/1960 10 MILLS BROOK LANE SHAMONG NJ 08088 DISQUALIFICATION 3/11/2019 MCGLOSTER, CARL L. DDS 12/5/1965 1962517839 90 TIFFANY BOULEVARD NEWARK NJ 07104 DISQUALIFICATION 5/20/2007 MCGRATH, HELEN J. RN 6/20/1950 6 BLAIR ROAD KENDALL PARK NJ 08824 SUSPENSION 10/20/2005 MCGRATH, ROBERT DC 6/22/1969 1417989864 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 9/20/2018 CHRISTOPHER MCGRATH, ROBERT DO 10/1/1951 1912110636 CANAAN USP, PO BOX 300 WAYMART PA 17837 DISQUALIFICATION 2/5/2019 CLAUDE MCGRATH, ROBERT DO 10/1/1951 1912110636 3411 KENWOOD COURT MAYS LANDING NJ 08330 DISQUALIFICATION 10/13/2020 PERMANENT CLAUDE MCINTYRE, JOHN G. DDS 10/8/1957 1487740718 1301 PENN AVENUE WYOMISSING PA 19610 DEBARMENT 6/22/2002 12/2/2011 MCKEAN JR., JOSEPH MD 7/14/1941 2601 MEADOW VIEW ROAD EDMOND OK 73013 DISQUALIFICATION 5/15/2000

MCKEITHAN, SHAVONNE LPN 1/31/1972 259 SECOND STREET HACKENSACK NJ 07601 DISQUALIFICATION 6/5/2017

MCKNIGHT, BOBBY 3/14/1986 4543 NORTH GRATZ STREET PHILADELPHIA PA 19140 DISQUALIFICATION 11/20/2015

MCLAUGHLIN, KELLY M. LPN 12/27/1971 SANDYBROOK ROAD MANALAPAN NJ 07726 SUSPENSION 8/20/2008 AKA FUNICELLO, KELLY MCLAY, WILLIAM MD 4/28/1944 1033133970/ 1150 GEORGIA AVENUE CAPE MAY NJ 08210 DISQUALIFICATION 7/16/2018 PERMANENT 1659585438 COURTHOUSE MCLEAN, EDWARD 506 MONTICELLO COURT MARLTON NJ 08053 SUSPENSION 7/18/2002 MCLEISH, FREDERICK RPH 7/11/1962 1447461504 5 WINDSOR DRIVE EGG HARBOR NJ 08234 DISQUALIFICATION 7/19/2017 PERMANENT TOWNSHIP MCLEOD, MEGHAN AKA CHHA 11/23/1992 271 SERPENTINE DRIVE BAYVILLE NJ 08721 DISQUALIFICATION 5/8/2019 WHITE, MEGHAN MCMAHON, THOMAS MD 11/2/1944 1952309742 121 WARWICK ROAD HADDONFIELD NJ 08033 DEBARMENT 2/15/2016 PERMANENT

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MCMURTRY-BURRELL, RPH 10/6/1965 1609015015 MDC BROOKLYN, PO BOX BROOKLYN NY 11232 DISQUALIFICATION 5/20/2015 DIANE 329002 MCMURTRY-BURRELL, RPH 10/6/1965 1609015015 MDC BROOKLYN, PO BOX BROOKLYN NY 11232 DISQUALIFICATION 11/20/2015 DIANE 329002 MCPHERSON, KIMBERLY CHHA 5/14/1987 110 THOMAS AVENUE LAWNSIDE NJ 08045 DISQUALIFICATION 2/8/2017 MCPHERSON, M. RPH 12/27/1971 269 HAMPTON STREET BRIDGETON NJ 08302 SUSPENSION 3/7/2008 LEEANNE MCQUEEN, BRITTANY CHHA 10/18/1987 807 N. INDIANA AVENUE ATLANTIC CITY NJ 08401 DISQUALIFICATION 1/23/2018 MCRAE, CHANEL CNA 4/27/1978 448 RAILROAD BOULEVARD RICHLAND NJ 08350 DISQUALIFICATION 2/23/2006

MEDICAL CLINICAL 373 LIVINGSTON AVENUE NEW BRUNSWICK NJ 08901 DISQUALIFICATION 7/29/1999 LABORATORIES MEDIPATH EXPRESS 666 PLAINSBORO ROAD PLAINSBORO NJ 08536 DISQUALIFICATION 1/14/2005 MEDISCOPE DIAGNOSTIC 1250 PARK AVENUE PLAINFIELD NJ 07060 SUSPENSION 11/16/1998 LAB MEDVEDIK, YELENA 10/15/1972 2 HICKORY HILLS COURT HOLMDEL NJ 07733 DISQUALIFICATION 10/3/2013 MEDVEDOVSKY, ANDREW DC 8/9/1982 1649431594 11 AUTUMN DRIVE MOORESTOWN NJ 08057 DISQUALIFICATION 8/4/2020

MEEHAN KIERMIER, DMD 11/18/1969 1245445931 1116 BENNETT DRIVE WOODBURY NJ 08096 DISQUALIFICATION 12/26/2018 4/9/2019 KATHLEEN MEHTA, MAHESH MD 9/17/1952 1396859385 157 RUTGERS PLACE NUTLEY NJ 07110 DISQUALIFICATION 4/2/2020 MEISHER, VLAD A. PSYCH 9/23/1939 HILLSIDE TERRACE FAIR LAWN NJ 07410 DISQUALIFICATION 8/10/2007 MEISHER, VLAD A. PSYCH 9/23/1939 15-07-PLAZA ROAD, APT. A FAIRLAWN NJ 07410 DISQUALIFICATION 8/1/2009 MELENDEZ, JUANITA COUNSE 6/16/1938 NORTH 35TH STREET CAMDEN NJ 08105 SUSPENSION 4/29/2003 MELENDEZ, LIZZADY CHHA 12/2/1984 602 SOUTH 4TH STREET CAMDEN NJ 08103 DISQUALIFICATION 1/26/2018 MELKER, NEIL L. DDS 11/7/1956 1053443705 219 VALLEY ROAD PRINCETON NJ 08540 DISQUALIFICATION 1/23/2009 MELTZER, SCOTT M. DMD 1/4/1964 1366561425 70 WELLESLEY WAY FREEHOLD NJ 07728 DISQUALIFICATION 4/17/2014 5/21/2020 MELTZER, SCOTT M. DMD 1/4/1964 1366561425 70 WELLESLEY WAY FREEHOLD NJ 07728 DEBARMENT 5/3/2013 5/21/2020 MEMBER, BERNARD J. MD 1/29/1948 12335 S. ANNA DRIVE ROCKVILLE MD 23146 SUSPENSION 5/20/2004 MENDEL, RICHARD 6/1/1961 1306939202 701 SO. HOWARD AVENUE, TAMPA FL 33606 DISQUALIFICATION 12/29/2015 SUITE 106 MENDEZ, EDELFONSO R. DO 11/16/1964 SMITH AVENUE NORTH BERGEN NJ 07047 DISQUALIFICATION 3/20/2008 MENDEZ, NORMA CHHA 2/6/1967 60 BALDWIN STREET, #2 NEW BRUNSWICK NJ 08901 DISQUALIFICATION 2/20/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MENSAH-NARH, STEVEN RPH 5/29/1962 WEDGEWOOD DRIVE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 2/20/2007 MEO, JOHN RPH 8/11/1954 1427086818 149 BOWNE ROAD WAYSIDE NJ 07712 DISQUALIFICATION 5/27/2009 MERVIL, DARLEIN CHHA 9/20/1988 122 ROSSITER AVENUE PATERSON NJ 07502 DEBARMENT 5/31/2018 MESA, NELSON PCA 3/28/1944 964 GROVE STREET, APT. A ELIZABETH NJ 07202 DISQUALIFICATION 4/17/2017 MESSICK, PAULA LPN 1/28/1957 105 SUMMIT AVENUE EWING NJ 08628 DISQUALIFICATION 6/18/2009 MESSO, RALPH MD 9/3/1961 1184798621/ 2 RICHMONDE COURT COLTS NECK NJ 07722 DEBARMENT 5/28/2015 1255309175 MESSO, RALPH MD 9/3/1961 1184798621/ FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 07722 DISQUALIFICATION 12/26/2018 1255309175 METTEAUX, IYANNAH CHHA 3/24/1989 46 N. ARLINGTON AVENUE EAST ORANGE NJ 07017 DISQUALIFICATION 2/8/2017 METZ, DANIEL 7/11/1980 FCI OTISVILLE #66799-050 OTISVILLE NY 10963 DISQUALIFICATION 7/20/2015 MEYER, CYNTHIA RN 12/12/1963 8200 KENNEDY BOULEVARD NORTH BERGEN NJ 07047 DISQUALIFICATION 2/20/2018

MEYER, GLORIA KINGS HIGHWAY MIDDLETOWN NJ 07748 DISQUALIFICATION 6/1/1993 MEYER, JOSEPH KINGS HIGHWAY MIDDLETOWN NJ 07748 DISQUALIFICATION 6/1/1993 MEYERLE, GISELA LPN 8/4/1966 1356538169 705 SUNFLOWER AVENUE, LANGHORNE PA 19047 DISQUALIFICATION 2/28/2018 UNIT A MEYERLE, GISELA LPN 8/4/1966 1356538169 705 SUNFLOWER AVENUE, LANGHORNE PA 19047 DISQUALIFICATION 5/25/2019 UNIT A MEZERENEZ, MARIA CHHA 7/8/1986 33 ASPEN PLACE PASSAIC NJ 07055 DISQUALIFICATION 3/6/2018 MGBEME, FESTUS RPH 8/22/1954 882 BROAD STREET NEWARK NJ 07114 DISQUALIFICATION 3/8/2001 MICHAIL, MEDHAT DDS 10/17/1959 848 BERGEN AVENUE JERSEY CITY NJ 07306 SUSPENSION 4/29/1998 MIKHAIL, PETER RPH 11/11/1978 48 FALLON AVENUE ELMONT NY 11003 DISQUALIFICATION 11/18/2004 MIKOS, KRISTEN RN 6/8/1979 2111 PRINCETON PIKE PHILADELPHIA PA 19149 DISQUALIFICATION 5/2/2017 MIKSIS, MARY E. RN 12/5/1958 126 WINSTEAD DRIVE WESTAMPTON NJ 08060 DISQUALIFICATION 2/17/2004 MIL, PAUL 11/2/1949 USP LEWISBURG, PO BOX LEWISBURG PA 17837 DISQUALIFICATION 2/9/2017 1000 MILAROLA CORPORATION 57 BROADWAY NEWARK NJ 07014 DISQUALIFICATION

MILLER, DEBBIE L. DO 6/6/1949 1750561866 94 EAST WATER STREET TOMS RIVER NJ 08753 DEBARMENT 4/26/2002 DECEASED MILLER, DEIDRE T. 12/23/1962 20 PERENNIAL LANE WILLINGBORO NJ 08046 DISQUALIFICATION 7/19/2001 MILLER, DEIDRE T. 12/23/1962 92 RITTENHOUSE DRIVE WILLINGBORO NJ 08046 DISQUALIFICATION 3/29/2000 MILLER, JOSEPH M. DO 4/19/1971 1255307856 9 VICTORIA CIRCLE JACKSON NJ 08527 DISQUALIFICATION 8/20/2015

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MILLER, JUSTIN PSYCH 2/1/1981 1952594921 616 DALE COURT WEST RIVERVALE NJ 07675 DISQUALIFICATION 1/2/2017 PERMANENT MILLER, RANDALL DO 1/3/1952 1740342575 1015 VAN HOUTEN AVENUE CLIFTON NJ 07013 DISQUALIFICATION 1/1/2001 4/6/2017

MILLER, ROY C. 703 WEST SHORE TRAIL LAKE MOHAWK NJ 07871 DISQUALIFICATION 6/1/1993 MILLER, SANDRENE A. MD 11/19/1948 1912192527 50 UNION AVENUE, SUITE IRVINGTON NJ 07111 SUSPENSION 2/25/1998 401 MILLER, SANDRENE A. MD 11/19/1948 1912192527 202 ELMWYND DRIVE ORANGE NJ 07050 SUSPENSION 7/22/1999 MILLET, CYNTHIA CHHA 6/10/1993 104 ROUTE 46 EAST ELMWOOD PARK NJ 07407 DEBARMENT 8/24/2017 MILMAN, BORIS 3/3/1951 655 AMBOY AVENUE WOODBRIDGE NJ 07095 DISQUALIFICATION 9/11/2001 MILORADOVICH, VADIM MD 5/11/1944 58 MERCER AVENUE HARTSDALE NY 10530 DISQUALIFICATION 11/20/2013 MILVIHILL, CHELSIE CHHA 11/5/1990 501 MAPLE STREET LAKEHURST NJ 08733 DEBARMENT 12/18/2017 MIMS, CAROLE 9/30/1946 1058 WILLOW STREET NORRISTOWN PA 19401 DISQUALIFICATION 11/20/2015 MINATEE, SHERAI LPN 1/2/1980 509 WARWICK ROAD LAWNSIDE NJ 08045 DISQUALIFICATION 3/15/2018 MINNOW, MARY CHHA 7/10/1958 9 WINDINGWOOD DRIVE SAYREVILLE NJ 08872 DISQUALIFICATION 7/25/2001 MIRAGLIA, ROBERT LCSW 10/1/1954 254 VOSE AVENUE SOUTH ORANGE NJ 07079 SUSPENSION 5/9/2002 MIRANDA, MEREDITH RPH 1/2/1983 1053740993 3204 BLUE MOUNTAIN LANE NAZARETH PA 18064 DISQUALIFICATION 10/25/2016

MIRILASHVILI, MOSHE B. MD 6/15/1948 1427081223 PO BOX 350146 BROOKLYN NY 11235 DISQUALIFICATION 11/17/1999 MIRZA, MUHAMMED MD 3/10/1942 1467450262 145 GARRISON AVENUE JERSEY CITY NJ 07306 DEBARMENT 5/8/2019 11/18/2019 MISHRA, ARUNA MD 8/10/1938 63 WEST BROADWAY SALEM NJ 08079 DISQUALIFICATION 2/4/1997 MISHRA, ARUNA MD 8/10/1938 317B AUBURN ROAD PILESGROVE NJ 08098 DEBARMENT 1/3/2000 MITRA, RANAJIT MD 1/12/1952 1417096942 2366 ST. GEORGES AVENUE RAHWAY NJ 07065 DEBARMENT 10/12/2014 MITRA, RANAJIT MD 1/12/1952 1417096942 2366 ST. GEORGES AVENUE RAHWAY NJ 07065 DISQUALIFICATION 7/20/2015 MITRESKI, IGOR MD 6/20/1978 1629305255 10 IVY LANE WALLINGTON NJ 07057 DISQUALIFICATION 3/26/2015 MITSUI, MASAO MD 6/19/1939 9 BRIARWOOD ROAD JERSEY CITY NJ 07305 SUSPENSION 12/20/2001 MOCKOVIAK, PATRICIA LPN 10/5/1954 5 BEECH STREET EDISON NJ 08817 SUSPENSION 2/19/2004 MODICA, JOSEPH CHHA 6/4/1979 82 JEFFERSON STREET SOUTH BOUND NJ 08880 DISQUALIFICATION 1/31/2017 MOHAMED, ASHLI CHHA 11/29/1990 10-4 FOUNTAIN AVENUE TRENTON NJ 08618 DISQUALIFICATION 1/31/2017 11/5/2018 MOHAMED, ASHLI CHHA 11/29/1990 10-4 FOUNTAIN AVENUE TRENTON NJ 08618 DEBARMENT 11/6/2018 MOHAMED, HASHIM H. 5/13/1965 PO BOX 8332 JERSEY CITY NJ 07308 DISQUALIFICATION 4/12/1994 MOHAMMAD, OMAR RPH 11/3/1977 1053580068 15 GRIST MILL LANE UPPER SADDLE RIVER NJ 07458 DISQUALIFICATION 1/20/2012 5/17/2018

MOHAMMAD, OMAR RPH 11/3/1977 1053580068 15 GRIST MILL LANE UPPER SADDLE RIVER NJ 07458 DISQUALIFICATION 9/20/2012 5/17/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MOHAPELOA, GUGU MD 8/31/1947 1306952636 6 CORNELL ROAD PARLIN NJ 08859 DISQUALIFICATION 1/3/2019 PERMANENT MOJICA, MARIA CHHA 11/27/1989 108 BEECH STREET PATERSON NJ 07501 DISQUALIFICATION 1/31/2017 MOLDAVER, INNA 1/19/1948 32 BEECHWOOD AVENUE EDISON NJ 08837 DEBARMENT 2/17/2016 MOLINA, DANIEL RPH 8/29/1961 320 EAST 42ND STREET, APT. NEW YORK NY 10017 DISQUALIFICATION 6/28/2017 618 MONACO, STEVEN 4/5/1982 21 JAMIE DRIVE SEWELL NJ 08080 SUSPENSION 4/9/2021 MONDELO, BARBARA AKA 12/14/1965 363 KENTWOOD BOULEVARD BRICK NJ 08724 DEBARMENT 10/24/2008 TAYLOR, BARBARA MONFORTO, CHRISTINE RN 7/6/1984 2620 HAMILTON DRIVE VOORHEES NJ 08043 DISQUALIFICATION 12/29/2015 MONICA, JULIANNE H. DC 4/12/1957 1235372608 509 ESSEX AVENUE SPRING LAKE NJ 07762 SUSPENSION 2/20/2002 MONK, SHENISE LPN 8/6/1990 416 CHAMBERS AVENUE CAMDEN NJ 08103 DISQUALIFICATION 10/24/2018 MONSUL, ROBERT W. MD 6/1/1931 301 NORTH MAIN STREET MANVILLE NJ 08835 DISQUALIFICATION 5/10/1990 MONTE, LYDA MD 9/27/1940 1114068236 430 W. BROWNING ROAD, BELLMAWR NJ 08031 DISQUALIFICATION 12/4/2018 PERMANENT APT. M2 MONTE, LYDA MD 9/27/1940 1114068236 430 W. BROWNING ROAD, BELLMAWR NJ 08031 DISQUALIFICATION 10/3/2019 APT. M2 MONTES, NANCY CHHA 5/21/1966 17-20 WELL DRIVE FAIR LAWN NJ 07410 DISQUALIFICATION 8/1/2017 MONTORIO, JENNIFER CHHA 2/11/1973 110 OUTER DRIVE DINGMANS FERRY PA 18328 DISQUALIFICATION 9/11/2019 MOON, RASHIKA RN 6/17/1970 2 JASON CIRCLE PENNS GROVE NJ 08069 DISQUALIFICATION 6/28/2017 MOONEY, MARY MELISSA LPN 5/24/1973 777 CHERRY TREE ROAD ASTON PA 19014 DISQUALIFICATION 4/23/2007 MOOR, JEAN RN 1/19/1956 100 COLONIAL WAY ALIQUIPPA PA 15001 DISQUALIFICATION 11/20/2015 MOORE, BRITTANY CHHA 2/28/1994 141 BORDEN AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 7/14/2017 MOORE, HANEEFAH CHHA 7/27/1983 48 MONTROSE TERRACE IRVINGTON NJ 07111 DISQUALIFICATION 10/3/2018 MOORE, JANE A. RN 2/27/1962 235 KINGS ROAD MADISON NJ 07940 SUSPENSION 5/19/2005 MOORE, JONATHAN R. MD 4/23/1917 19 N. PEARL STREET BRIDGETON NJ 08302 DISQUALIFICATION 8/19/1997 MOORE, LILLIE, R. 8/31/1961 353 S. CENTER STREET, APT. ORANGE NJ 07050 SUSPENSION 10/20/2002 19 MOORE, LYNDA A. LPN 1/13/1968 10719 JUREL COURT W. APT. LAKEVILLE MN 55044 SUSPENSION 1/19/2005 B MOORE, MONICA AKA 2/1/1969 27 FIRETOWER ROAD BUDD LAKE NJ 07828 DEBARMENT 9/15/2017 OZERY, TZIPORA MOORJANI, KAMAL RPH 7/3/1970 217 VAN BUREN STREET LYNDHURST NJ 07071 DISQUALIFICATION 6/1/2010 8/26/2016

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MOORMANN, BARBARA CHHA 11/3/1947 2467 BREATHSTONE DRIVE POWELL OH 46065 DISQUALIFICATION 2/20/2017 ANN MORALES SR., OSVALDO 8/26/1948 78 W. 180TH STREET, 2ND FL BRONX NY 10453 SUSPENSION 4/13/2008

MORALES SR., OSVALDO 8/26/1948 78 W. 180TH STREET BRONX NY 10453 DISQUALIFICATION 9/16/2011 MORALES, ARLENE 3/18/1956 254 NORTH 7TH STREET NEWARK NJ 07107 SUSPENSION 9/19/2002 MORALES, CHRISTINO 8/22/1964 328 MARKET STREET CAMDEN NJ 08102 SUSPENSION 10/5/2000 MORALES, CHRISTINO 8/22/1964 PO BOX 26883 PHILADELPHIA PA 19134 SUSPENSION 7/2/2003 MORALES, FERNANDO CNA 2/18/1981 346 S. MAIN STREET PHILLIPSBURG NJ 08865 SUSPENSION 12/21/2004 MORALES, JAMES MD 3/8/1970 1386649507 16 WOODVIEW DRIVE HOWELL NJ 07731 DEBARMENT 4/11/2016 MORALES, JAMES MD 3/8/1970 1386649507 2319 CRYSTAL MILE COURT TOMS RIVER NJ 08755 SUSPENSION 1/11/2016 4/11/2016 MORALES, JAMES MD 3/8/1970 1386649507 16 WOODVIEW DRIVE HOWELL NJ 07731 DISQUALIFICATION 11/30/2017 MORALES, JUSTINA CHHA 4/7/1991 62 HIGH STREET WOODBURY NJ 08096 DISQUALIFICATION 2/8/2017 MOREL, MARIA CHHA 5/25/1974 735 TWENTY SECOND STREET PATERSON NJ 07504 DISQUALIFICATION 7/14/2017

MORELAND, CHARLOTTE CNA 1/21/1965 121 PROSPECT VILLAGE, APT. TRENTON NJ 08618 DISQUALIFICATION 4/29/2008 A MORELAND, CHARLOTTE CNA 1/21/1965 121 PROPECT VILLAGE, APT. TRENTON NJ 08618 SUSPENSION 9/20/2008 A MORELLI, TIMOTHY J. RPH 10/28/1955 801 BUTLER PIKE MERCER PA 16137 SUSPENSION 5/19/2005 MORELOS, LISA A. RN 3/14/1965 162 SHENANDOAH TOMS RIVER NJ 08753 SUSPENSION 6/19/2003 BOULEVARD MORENO, BARTOLO COUNSE 6/27/1959 2221 38TH STREET PENNSAUKEN NJ 08110 SUSPENSION 4/29/2003 MORERA, JESSICA CHHA 12/31/1981 116 DALTON STREET ROSELLE PARK NJ 07204 DISQUALIFICATION 2/8/2017 MORGANSTEIN, HENRY DO 9/14/1939 1689730343 774 CARTERET COURT MOUNT LAUREL NJ 08054 DISQUALIFICATION 11/23/2010 MORGANSTEIN, HIRAM N. OD 9/26/1918 5618 BERGENLINE AVENUE WEST NEW YORK NJ 07093 DEBARMENT 2/22/2001

MORIARTY, JACK 4/4/1952 312 GRANDE RIVER TOMS RIVER NJ 08755 SUSPENSION 4/8/1999 BOULEVARD MORRIS, CANDICE CHHA 6/26/1980 154 NORTH SPRING STREET, BLOOMFIELD NJ 07003 DISQUALIFICATION 6/22/2018 PERMANENT UNIT B MORRIS, CHRISTINE CHHA 12/3/1984 323 KAIGHN AVENUE CAMDEN NJ 08103 DISQUALIFICATION 5/16/2018 MORRISON, JAMES C. MD 2/13/1927 RADIO ROAD AT EAST BOAT TUCKERTON NJ 07087 DISQUALIFICATION 6/1/1993

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MORTON, MARION RPH 3/3/1966 2321 SPRUILL AVENUE, APT. NORTH CHARLESTON SC 29405 DEBARMENT 2/6/2012 917 MOSHKOVITCH, VASIL MD 4/22/1955 1326116419 41 NAUTILUS DRIVE MANAHAWKIN NJ 08050 DISQUALIFICATION 11/22/2016 PERMANENT MOSHKOVITCH, VASIL MD 4/22/1955 1326116419 41 NAUTILUS DRIVE MANAHAWKIN NJ 08050 DISQUALIFICATION 3/3/2017 PERMANENT MOSKOWITZ, MYRON DPM 1/21/1942 705 RIDGE DRIVE UNION NJ 07083 SUSPENSION 11/20/2006 MOSS, ALBERT H. MD 10/20/1940 28 BARTLE ROAD SOMERSET NJ 08873 SUSPENSION 5/19/2005 MOSS, ROBERT H. DPM 5/15/1968 1881716348 244 N. MAIN STREET MULLICA HILL NJ 08062 DEBARMENT 11/2/2011 MOSS, ROBERT H. DPM 5/15/1968 1881716348 FCI OTISVILLE, PO BOX 1000 OTISVILLE NY 10963 DISQUALIFICATION 11/20/2015

MOSS, ROBERT H. DPM 5/15/1968 1881716348 244 NORTH MAIN STREET MULLICA HILL NJ 08062 DISQUALIFICATION 2/20/2013 MOSSAVI, AHMAD MD 11/8/1944 1629046248 7 MALKE DRIVE OCEAN NJ 07712 DEBARMENT 2/23/2012 MOTA, KAESHA CHHA 1/2/1994 433 N. 7TH STREET CAMDEN NJ 08102 DISQUALIFICATION 7/14/2017 MOTT, TARA RN 2/28/1982 3557 SHARON ROAD WEST MIDDLESEX PA 16159 DISQUALIFICATION 11/20/2015 MOULDER, DARIA PHARM 1/16/1962 2715 BAYSHORE ROAD VILLAS NJ 08251 DISQUALIFICATION 4/20/2010 MOUNT LAUREL CENTER 1851669287 3718 CHURCH ROAD MOUNT LAUREL NJ 08054 DISQUALIFICATION 7/16/2017 FOR REHAB AND HEALTHCARE MOURACHOV, PAVEL 8/26/1971 1083711121 3917 WEST ROAD, SUITE 137 LOS ALAMOS NM 87544 DISQUALIFICATION 12/29/2015

MOZULAY, MARK J. MD 6/23/1957 1669631719 512 TOWNSHIP LANE BLUE BELL PA 19422 SUSPENSION 12/1/1998 MUHAMMAD, ABDUL B. MD 11/19/1942 284 BROADWAY NEWARK NJ 07104 DISQUALIFICATION 11/8/2004 PERMANENT MUHAMMAD, CHHA 3/10/1992 354 7TH AVENUE WEST NEWARK NJ 07107 DISQUALIFICATION 7/14/2017 DIAMONNIQUE MUID, JANNAH 1/3/1984 671 LINCOLN AVENUE ORANGE NJ 07050 DISQUALIFICATION 11/18/2010 MUISE, NICOLLETE CHHA 11/3/1990 172 FRANKLIN ROAD DENVILLE NJ 07834 DISQUALIFICATION 11/8/2017 MUKHTAR, JUNAID 9/6/1960 114 BALDWIN AVENUE JERSEY CITY NJ 07306 SUSPENSION 6/5/1997 MULLANGI, KUMAR R. MD 12/9/1965 SOUTH BROADWAY STREET BURLINGTON IA 52601 SUSPENSION 5/20/2008

MULLIGAN, RACHEL M. 2/7/1978 241 HAWAII DRIVE BRICK NJ 08723 DISQUALIFICATION 4/11/2008 MULTANI, GURMEET PSYCH 4/14/1955 1528225406 1055 CALLE DE LAS PALM REDLANDS CA 92373 DISQUALIFICATION 6/9/2011 MUNGEN, JONETTA V. CHHA 9/30/1972 34 VERMONT AVENUE NEWARK NJ 07106 SUSPENSION 6/20/2001 MUNN, DONIELLE CHHA 5/26/1984 150 HOME AVENUE, FL. 2 TRENTON NJ 08611 DISQUALIFICATION 2/8/2017 MUNOZ, GUILLERMO DO 1/20/1965 1023071669 824 ELIZABETH AVENUE ELIZABETH NJ 07201 DEBARMENT 11/25/2015 5/13/2016

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE MUNOZ, JULIO ANTHONY 1/22/1965 4 NORMAL AVENUE UPPER MONTCLAIR NJ 07043 DEBARMENT 10/26/2006

MUNSIF, ANAND MD 11/10/1956 1982879805 127 E. NORTHFIELD ROAD LIVINGSTON NJ 07039 DEBARMENT 11/7/2011 MUNZEL, GREGORY 3/5/1976 140 WAPPOO CREEK DRIVE CHARLESTON SC 29412 DEBARMENT 4/22/2012 THOMAS MURRAY, LAKIRAH LPN 10/2/1985 1311 NE 77TH AVENUE GAINESVILLE FL 32609 DEBARMENT 1/5/2018 MURRY JR., TOMMIE 11/20/1958 2697 RAVEN ROAD CINNAMINSON NJ 08077 SUSPENSION 5/25/1999 MURRY JR., TOMMIE 11/20/1958 2697 RAVEN ROAD CINNAMINSON NJ 08077 DEBARMENT 1/5/2001 MURRY JR., TOMMIE 11/20/1958 2697 RAVEN ROAD CINNAMINSON NJ 08077 DEBARMENT 10/20/2002 MUSARRA, GERALD C. DMD 1/3/1920 525 WASHINGTON AVENUE HOBOKEN NJ 07030 DISQUALIFICATION MUSCIO, ROBERT MD 9/8/1973 1578510723 333 BROAD STREET RED BANK NJ 07701 DISQUALIFICATION 3/19/2015 MYERS, HOWARD MD 10/30/1939 103 FAIRWAY TERRACE MOUNT LAUREL NJ 08054 DISQUALIFICATION 12/1/1998 MYNDIUK, JAROSLAW MD 4/19/1910 96 TUXEDO PARKWAY NEWARK NJ 07106 DISQUALIFICATION 2/27/1988 DECEASED NAGLE, BRITTANY RN 1/13/1988 709 NORTH VICTORIA VENTNOR CITY NJ 00840 DISQUALIFICATION 10/25/2016 AVENUE NAIMOLI, DANIELLE 7/8/1979 824 HOLIDAY COURT TOMS RIVER NJ 08753 SUSPENSION 9/30/2005 NALBONE, PHILLIP C. RN 5/13/1969 24 RUNNING BROOK ROAD TRENTON NJ 08638 SUSPENSION 6/17/2004 NANDI, ANINDITA MD 11/22/1972 1669563995 127 HIGHLAND AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 9/12/2018 NAPENAS, VICTOR T. 1/4/1947 14 SPRUCE LANE PISCATAWAY NJ 08854 DISQUALIFICATION 5/20/2012 NAPENAS, VICTOR T. 1/4/1947 14 SPRUCE LANE PISCATAWAY NJ 08854 DISQUALIFICATION 11/17/2011 NARAYAN, PRITHVI MD 7/28/1961 1982699823 33 COOPER AVENUE, UNIT LONG BRANCH NJ 07740 DISQUALIFICATION 2/25/2021 PERMANENT 213 NARO, MARYANN LPN 5/15/1970 23 DOWNING ROAD HAMILTON NJ 08690 DISQUALIFICATION 5/25/2019 NASH, JENNIFER RN/APN 11/30/1969 621 ASTER LANE RIVERVALE NJ 07675 DEBARMENT 7/3/2016 NASSAU PHARMACY 80 NASSAU STREET PRINCETON NJ 08540 DISQUALIFICATION NASSERY, MOHAMMAD MD 4/18/1952 1992763510 59 TREELINE DRIVE MARSTONS MILLS MA 02648 DISQUALIFICATION 11/9/2016 NATALE, JOSEPH 2/8/1962 216 NORTH AVENUE E, STE. CRANFORD NJ 07016 SUSPENSION 1/24/2014 2 NATHAN, MICHAEL MD 11/3/1946 1578593422 1 PROSPECT LANE OKATIE SC 29909 DEBARMENT 8/1/2017 NATIONAL SPINE 2103 GOLDEN POND DRIVE KINGWOOD TX 77345 SUSPENSION 4/20/2005 MEDICAL CENTER NATOVICH, BORIS 2/25/1947 996 PINE TERRACE FRANKLIN LAKES NJ 07417 SUSPENSION 9/18/2003 NATOVICH, LEV 5/28/1968 996 PINE TERRACE FRANKLIN LAKES NJ 07417 SUSPENSION 9/18/2003 NAVAZIO, DAVID 11/22/1960 1368 BRENTWOOD ROAD YARDLEY PA 19067 SUSPENSION 6/7/2000 1/5/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE NAYLOR, KIM M. PHARM 9/15/1958 1504 TAMIAMI ROAD FORKED RIVER NJ 08731 DEBARMENT 9/19/2011 NAZARIO, JULISSA CHHA 6/6/1992 210 ROSEVILLE AVENUE, APT. NEWARK NJ 07107 DISQUALIFICATION 2/20/2017 C1 NEAL, LAYONA CHHA 4/5/1983 545 E. TOILE COURT BURLINGTON NJ 08016 DISQUALIFICATION 7/13/2018 NEALS, SHERRY CHHA 12/19/1974 63 DALES AVENUE, APT. 1124 JERSEY CITY NJ 07306 SUSPENSION 9/20/2001

NEGRI, MARY JEAN RN/DC 11/21/1956 1063594836 514 LAFAYETTE ROAD, SUITE SPARTA NJ 07871 DISQUALIFICATION 5/20/2015 F NEGRON, JOANNA CHHA 7/24/1982 1343 LANDSDOWNE AVENUE CAMDEN NJ 08104 DISQUALIFICATION 5/2/2017

NELSON, SIDNEY MD 4517 BERGENLINE AVENUE UNION CITY NJ 07087 DEBARMENT 9/13/1999 NESSMAN, LAWRENCE DO 8/3/1931 143 GREENRALE AVENUE WAYNE NJ 07470 DISQUALIFICATION 6/24/1997 NEWBY, YVONNE CHHA 11/20/1966 38 WINANS STREET, APT. 3 EAST ORANGE NJ 07018 DISQUALIFICATION 8/29/2017 NEWMAN, ALEXANDER PHD 11/8/1947 372 N. WOODLAND STREET ENGLEWOOD NJ 07631 DEBARMENT 3/10/1999 NEWMAN, MICHAEL J. DMD 11/22/1954 192 GABRIEL TERRACE SOUTH AMBOY NJ 08879 DISQUALIFICATION 7/18/2001 NEWMARK, MALINDA RN 2/7/1969 38 STONY HILL ROAD, APT. MONROE TOWNSHIP NJ 08831 SUSPENSION 5/19/2005 101 NEWMARK, THOMAS PSYCH 12/8/1944 1740380997 2250 CHAPEL AVENUE CHERRY HILL NJ 08002 DISQUALIFICATION 12/19/2016 PERMANENT NEWMARK, THOMAS PSYCH 12/8/1944 1740380997 4700 CITY AVENUE, APT. PHILADELPHIA PA 19131 DISQUALIFICATION 4/17/2017 PERMANENT 11307 NEWSOME, DORITA DDS 1/22/1956 1306063235 163 CHAPEL STREET ORANGE NJ 07050 DISQUALIFICATION 1/23/2009 NEWTON, ANDREW PSYCH 12/18/1961 1154349330 129 EAST 5TH STREET MOUNT CARAMEL PA 17851 DISQUALIFICATION 11/20/2015 NGOAJIA, MARK 7/23/1987 403 WILLOW POINT DRIVE JACKSON NJ 08724 DEBARMENT 12/16/2015 NGUYEN, TONY MD 10/7/1979 1083872675 10294 GREENSPIRE DRIVE OAKTON VA 22124 DISQUALIFICATION 9/28/2017 NIAZ, ASIM 7/11/1960 PO BOX 420 FAIRTON NJ 08320 SUSPENSION 8/19/2010 NICHOLSON, BEVERLY CNA 6/3/1947 139 HOLLYWOOD AVENUE EAST ORANGE NJ 07108 DISQUALIFICATION 1/13/2006 NICOLL, DAVID G. 3/10/1974 312 BOULEVARD MOUNTAIN LAKES NJ 07046 SUSPENSION 1/21/2015 7/4/2019 NICOLL, DAVID G. #65321- 3/10/1974 USP CANAAN, PO BOX 300 WAYMART PA 18472 DISQUALIFICATION 7/4/2019 050 NICOLL, SCOTT R. 9/20/1980 120 BUNKER HILL ROAD WAYNE NJ 07470 SUSPENSION 1/21/2015 NICOSIA, BETTY LOU 6/23/1945 204 CIRCLE DRIVE STEUBENVILLE OH 43953 DISQUALIFICATION 12/29/2015 NIELSON, STEVEN C. DPM 10/22/1963 1538595772 845 DAWN AVENUE EPHRATA PA 17522 SUSPENSION 3/23/2009 NIGALAN, MANUEL MD 12/5/1943 1497809909 8 MIMI COURT NORTHFIELD NJ 08225 DISQUALIFICATION 10/14/2010

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE NII, ROBERT PA 12/25/1965 1124254107 34 MILL BROOK ROAD PISCATAWAY NJ 08854 DISQUALIFICATION 9/21/2016 PERMANENT NINOS, DIANE E. 12/11/1975 569 E. 33RD STREET PATERSON NJ 07613 DISQUALIFICATION 3/28/2001 NISBETT, MELVIN CHHA 6/23/1990 205 LA CASCATA CLEMENTON NJ 08021 DISQUALIFICATION 2/8/2017 NISIVOCCIA, CHARLES DC 1/29/1967 260 MAIN STREET LITTLE FALLS NJ 07424 SUSPENSION 8/20/2006 NISLER, JANIS RN 8/23/1984 127 WEST WOODBRIDGE ISELIN NJ 08830 DISQUALIFICATION 1/24/2019 AVENUE NOBLES, MARITZA CHHA 9/2/1986 34 CENTER OAK AVENUE LAWNSIDE NJ 08045 DISQUALIFICATION 2/8/2017 NOBORE, ABIEYUWA CHHA 7/20/1986 776 SOUTH 13TH STREET NEWARK NJ 07108 DEBARMENT 2/20/2017 NOEL, EDWARD LPN 8/9/1980 469 E. 93RD STREET, APT. 6 BROOKLYN NY 11212 DISQUALIFICATION 10/25/2019 NONCENT, JENNIFER CHHA 6/2/1994 949 CARTERT AVENUE UNION NJ 07083 DISQUALIFICATION 2/8/2017 NONZIATO, CHARLES G. DO 2/26/1915 247 CENTER STREET TRENTON NJ 08611 DISQUALIFICATION 11/13/1991 DECEASED NOOR, FARID A. MD 6/26/1956 1770751513 5 GITHERS LANE MEDFORD NJ 08055 SUSPENSION 4/12/2004 NOOR, FARID A. MD 6/26/1956 1770751513 350 A DELANCEY PLACE MOUNT LAUREL NJ 08054 DISQUALIFICATION 8/19/2008 NOOR, FARID A. MD 6/26/1956 1770751513 596 ANDERSON AVENUE CLIFFSIDE PARK NJ 07010 DEBARMENT 1/30/2015 NORDMAN, CRAIG J. 11/14/1978 4 ERNA PLACE WHIPPANY NJ 07981 SUSPENSION 1/21/2015 5/18/2019 NORDMAN, CRAIG J. 11/14/1978 FCI SCHUYKILL, PO BOX 759 MINERSVILLE PA 17954 DISQUALIFICATION 5/18/2019

NORTH END FAMILY 1013079888 644 MT. PROSPECT AVENUE NEWARK NJ 07104 DISQUALIFICATION 7/20/2018 MEDICAL CARE, INC. NORTHGATE 156 COUNTRY FARM ROAD MARLTON NJ 08053 DISQUALIFICATION 3/6/2006 COMMUNITY PHARMACY

NOWINSKI, VANESSA AKA RN 3/21/1977 65 LOCUST AVENUE NORTH ARLINGTON NJ 07031 SUSPENSION 9/19/2003 AMATO, VANESSA NSIAH, KENNETH CHHA 6/25/1985 827 S. 17TH STREET, 2ND FL. NEWARK NJ 07108 DEBARMENT 7/14/2017

NTSHONA, NOKUZOLA S. MD 9/25/1951 113-15 34TH AVENUE, #4B CORONA NY 11368 DEBARMENT 1/12/2000

NURIK, BARUCH APT 9C PARKVIEW & LAURENCE HARBOR NJ 08879 DISQUALIFICATION 4/30/1995 MADISON NUSSBAUM, ABRAHAM MD 7/28/1950 1578598082 91 MONTGOMERY STREET RHINEBECK NY 12572 SUSPENSION 1/15/2001 11/12/2013 NUTT, TRACY RN 9/15/1963 27 OVERLOOK DRIVE MOUNT LAUREL NJ 08054 DISQUALIFICATION 5/11/2019 NWANKWO, FESTUS RPH 7/27/1959 154 BLOOMFIELD AVENUE NEWARK NJ 07104 DISQUALIFICATION 11/18/1998

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE NWANKWO, FESTUS RPH 7/27/1959 306 ARDSDALE TERRACE UNION NJ 07083 DISQUALIFICATION 2/18/1999 NWANKWO, RAPHAEL 7/4/1949 278 PARK AVENUE NEWARK NJ 07107 DISQUALIFICATION 5/19/1999 O'BRIEN, ELIZABETH AKA 9/2/1960 2201 BENJAMIN FRANKLIN PHILADELPHIA PA 19130 DISQUALIFICATION 5/18/2019 HIBBS, ELIZABETH PARKWAY, APT. 807 O'CALLAGHAN, TERESE RN 12/12/1958 5122 ORCHARD WAY PENNSAUKEN NJ 08109 SUSPENSION 10/20/2002 OCANSEY, DONNA RN 2/1/1962 7 WISINA COURT MEDFORD NJ 08055 DEBARMENT 4/22/2012 7/19/2019 OCCEAN, NERLANDE CHHA 9/29/1974 811 DILL AVENUE LINDEN NJ 07036 DISQUALIFICATION 2/8/2017 O'CONNELL, MARK MD 2/19/1954 1669514253 18 CENTER STREET, REAR RUMSON NJ 07760 DEBARMENT 11/9/2015 ODOMS, TIFFANY E. 9/3/1983 926 TILGHMAN STREET CHESTER PA 19013 DISQUALIFICATION 11/18/2008 O'DONNELL, KATHERINE 1/23/1975 141 MAIN STREET METUCHEN NJ 08840 DISQUALIFICATION 9/30/2005 O'DONNELL, LISA RN 5/12/1976 845 BROADWAY BAYONNE NJ 07002 DISQUALIFICATION 6/15/2018 O'DONNELL, WILLIAM DC 9/15/1976 1659601177 7 NINEBACK LANE OXFORD NJ 07863 DISQUALIFICATION 3/28/2019 ODUNZEH, UCHE 10/28/1981 3565 LAUREL FORTE MEADE LAUREL MD 20724 DISQUALIFICATION 11/20/2015 ROAD, APT. 41 OFFOR, CHINWE MD 3/4/1962 1508811019 15 CHABLIS DRIVE DIX HILLS NY 11746 DISQUALIFICATION 4/11/2019 OFFOR, CHINWE MD 3/4/1962 1508811019 15 CHABLIS DRIVE DIX HILLS NY 11746 DISQUALIFICATION 6/12/2019 OGANDO LOPEZ, CHHA 7/27/1985 943 SHERIDAN AVENUE ELIZABETH NJ 07208 DEBARMENT 4/18/2017 6/28/2018 ERNESTINA OGBEIDE-SIMMS, RACHEL CHHA 10/27/1965 15 MAPES PLACE NEWARK NJ 07112 DISQUALIFICATION 2/8/2017

OGORODOVA, GANNA CHHA 6/17/1983 310 BROMLEY PLACE EAST BRUNSWICK NJ 08816 DISQUALIFICATION 2/20/2017 OGUNTUASE, EBENEZER PHY 10/16/1959 10 DOCKSIDE DRIVE EGG HARBOR NJ 08234 DISQUALIFICATION 6/20/2009 O'HERN, DANIEL MD 3/8/1950 1144369554 18 FLEETWOOD DRIVE GOSHEN NY 10924 DISQUALIFICATION 3/3/2017 PERMANENT OJAH CORPORATION 42/44 SUSSEX AVENUE EAST ORANGE NJ SUSPENSION 3/22/2006 OJIKYTU, SIMBIAT T. CHHA 5/5/1987 51 LEXINGTON BLVD BARNEGAT NJ 08005 DISQUALIFICATION 5/2/2014 OJO, RICHARD O. 9/10/1986 346 FIELDCREST AVENUE NEW EGYPT NJ 08533 DEBARMENT 2/24/2009 OKANTA, MARGARET CHHA 11/11/1941 1854B MANOR DRIVE UNION NJ 07083 DEBARMENT 7/30/2005 OKOYE, GODWIN S. RPH 1/1/1962 289 GEORGE STREET NEW BRUNSWICK NJ 08901 SUSPENSION 1/12/2001 OKOYE, PATRICK C. RPH 5/2/1970 289 GEORGE STREET NEW BRUNSWICK NJ 08901 SUSPENSION 1/12/2001 OKREM, JANINE RN 10/21/1970 1112 HARKER AVENUE WEST DEPTFORD NJ 08096 DISQUALIFICATION 7/12/2018 OLDE MEDFORD 1619148632 639 STOKES ROAD, SUITE 101 MEDFORD NJ 08055 DISQUALIFICATION 4/13/2018 PHARMACY OLIVEIRA JR., MARIO OD 4/8/1963 170 EAST KINNEY STREET NEWARK NJ 07105 DEBARMENT 4/28/2005

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE OLIVER, ANDREA AKA APN/RN 7/26/1979 1780630418 70 COHANSEY STREET BRIDGETON NJ 08302 DISQUALIFICATION 9/12/2016 5/21/2020 SCHLEMBACH, ANDREA OLIVER, JAMES DDS 3/1/1946 1134314594 167 MAIN STREET METUCHEN NJ 08840 DEBARMENT 8/13/1999 OLIVERA, PABLO R. DPM 4/28/1958 2 CEDAR STREET NEWARK NJ 07102 SUSPENSION 9/20/2001 OLIVERA, SMIRNA LPN 8/15/1958 33 REMSEN AVENUE NEW BRUNSWICK NJ 08901 SUSPENSION 10/20/2002 OLIVEROS, APRIL LPN 4/2/1985 233 SMOKERISE LANE TOMS RIVER NJ 08755 DISQUALIFICATION 6/5/2017 OLIYNYK, OKSANA CHHA 5/9/1970 591 MARLBORO ROAD OLD BRIDGE NJ 08857 DEBARMENT 2/20/2017 OMAR, HATIEM 4/20/1966 1116 ANNE STREET ELIZABETH NJ 07201 DISQUALIFICATION 11/10/1999 OMAR, MUGAHID O. 3/29/1967 7-11 TONNELLE AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 3/14/1998 OMAR, MUGAHID O. 3/29/1967 7-11 TONNELLE AVENUE- JERSEY CITY NJ 07306 DISQUALIFICATION 4/10/1997 2MN O'NEILL - RYAN, LISA COUNSE 8/20/1961 415 LYNDALE STREET PHILLIPSBURG NJ 08865 DISQUALIFICATION 8/17/2008 ANNE LOR O'NEILL - RYAN, LISA COUNSE 8/20/1961 415 LYNDALE STREET PHILLIPSBURG NJ 08865 SUSPENSION 5/9/2008 ANNE LOR ONYEKAHA, EBERE RPH 11/15/1958 13 HIGHLAND AVENUE MAPLEWOOD NJ 07040 DISQUALIFICATION 12/1/1998 ONYENSO, CHIKEZIE MD 9/18/1958 1578605812 552 MAIN STREET CHATHAM NJ 07928 SUSPENSION 2/15/2012 5/6/2021 ONYENSO, CHIKEZIE MD 9/18/1958 1578605812 18 EDINBURGH DRIVE RANDOLPH NJ 07869 DISQUALIFICATION 3/19/2015 5/6/2021 OPOKU, BISMARK CHHA 6/14/1968 2468 ANGLER ROAD COLUMBUS OH 43224 DISQUALIFICATION 4/6/2018 OQUENDO, BASHIRAH CHHA 11/6/1986 87 MANNING AVENUE PLAINFIELD NJ 07060 DISQUALIFICATION 2/8/2017 ORANGE COMMUNITY 345 HENRY STREET ORANGE NJ 07055 SUSPENSION 3/16/2012 MRI O'REILLY, MARGARET RN 11/30/1957 38 REILEY MOUNTAIN ROAD CUDDEBACKVILLE NY 12729 DISQUALIFICATION 2/25/2019

O'REILLY, RAYMOND B 2/20/1949 188 ALEXANDRIA DRIVE HACKETTSTOWN NJ 07840 DISQUALIFICATION 6/1/1993 OREM, SUSAN RN 5/18/1960 140 VALERIE DRIVE #488 MANVILLE NJ 08835 SUSPENSION 9/20/2006 ORIA, CONRAD RN 7/26/1976 525 BLOOMFIELD AVENUE CALDWELL NJ 07006 DEBARMENT 6/5/2017 ORT II, CHARLES C. PA 10/4/1957 PO BOX 481 HACKETTSTOWN NJ 07840 DISQUALIFICATION 11/18/2004 ORTEGA, ANA CHHA 11/16/1967 14 PALM STREET MONMOUTH NJ 08852 DISQUALIFICATION 2/8/2017 ORTEGA, VICTOR 10/14/1967 GUAYNBO- PO BOX 2147 SAN JUAN PR 00922 SUSPENSION 7/18/2002 ORTELL, CARL RPH 7/30/1937 221 TINDERBOX LANE MARLTON NJ 08053 DISQUALIFICATION 12/5/1983 OSAIGBOVO, ASHLEY CHHA 3/25/1994 130 PAMPHYLIA AVENUE, BRIDGETON NJ 08302 DISQUALIFICATION 10/19/2017 APT. #70

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE OSEI, CALVIN RPH 8/24/1977 1497931794 2 SYSLO COURT SAYREVILLE NJ 08872 DISQUALIFICATION 9/4/2012 6/12/2018 OSEI, FRANCIS LPN 4/9/1966 50 N. EVERGREEN ROAD, EDISON NJ 08837 DISQUALIFICATION 8/24/2017 APT. 170M OSEI, PASCAL RPH 11/11/1958 9 SOUTH GROSSER PLACE SOMERSET NJ 08873 DEBARMENT 7/17/2009 7/17/2014 OSIFO, BAHEEJAH CHHA 9/11/1979 530 PARK AVENUE ORANGE NJ 07050 DISQUALIFICATION 2/8/2017 OSMANOFF, GARY DDS 5/13/1962 1710188073 NETTER COURT MARLBORO NJ 07746 DISQUALIFICATION 6/23/2008 OSMANOFF, GARY DDS 5/13/1962 1710188073 317 MARINE AVENUE BROOKLYN NY 11209 SUSPENSION 12/17/2008 OSTERGAARD, PAUL MD 3/15/1941 1962504753 230 WEST PARKWAY POMPTON PLAINS NJ 07444 DEBARMENT 2/21/2014 OSTERGAARD, PAUL MD 3/15/1941 1962504753 15 MOUNTAIN AVENUE POMPTON PLAINS NJ 07444 DISQUALIFICATION 2/11/2016 OSTERGAARD, PAUL MD 3/15/1941 1962504753 230 WEST PARKWAY POMPTON PLAINS NJ 07444 DEBARMENT 12/16/2015 OSTROSKIE, JOAN LPN 4/3/1953 424 FLORENCE STREET NEW MILFORD NJ 07646 SUSPENSION 1/19/2003 OSTWALD, ALICE LPN 2/7/1962 11 RAILROAD LANE WHITEHOUSE NJ 08889 SUSPENSION 9/20/2006 OSUJI, PAUL 12/7/1963 FCI FORT DIX, PO BOX 2000 FORT DIX NJ 08640 SUSPENSION 8/20/2009 OSWARI, DANIEL MD 6/11/1971 1265506489 35 ALLEGHANY LANE BORDENTOWN NJ 08505 DISQUALIFICATION 6/30/2020 OTI, CHUCK B. 9/1/1973 676 PARK AVENUE, BLDG. EAST ORANGE NJ 07017 DISQUALIFICATION 1/31/2000 14B OTISMED CORPORATION 1600 HARBOR BAY ALAMEDA CA 94502 DISQUALIFICATION 4/27/2015 PARKWAY, SUITE 200 OTOO, LOVE CHHA 5/21/1957 555 ELIZABETH AVENUE NEWARK NJ 07112 DISQUALIFICATION 2/8/2017 OTTENSTEIN, ALAN MD 6/1/1956 3100 PRINCETON PIKE LAWRENCEVILLE NJ 08648 SUSPENSION 3/1/2009 OTTENSTEIN, ALAN MD 6/1/1956 173 MOUNT EYRE ROAD WASHINGTON PA 18977 SUSPENSION 5/19/2005 CROSSING OWUSU, NICHOLAS CHHA 2/3/1955 6063 HAMPSTEAD DRIVE W COLUMBUS OH 43229 DISQUALIFICATION 2/27/2017 PERMANENT OWUSU,-ANSAH, GRACE CHHA 9/21/1963 97-22 57TH AVENUE CORONA NY 11368 DISQUALIFICATION 5/17/2018 OXFORD DIABETIC 1700016045 53 FRONTAGE ROAD, SUITE HAMPTON NJ 08827 DISQUALIFICATION 12/8/2016 SUPPLY, INC. 100 OXMAN, REED S. MD 3/8/1959 1649575473 226 W. RITTENHOUSE PHILADELPHIA PA 19103 SUSPENSION 3/16/2012 SQUARE OYENUSI, ADEBOWALE RPH 4/4/1956 90 WASHINGTON STREET EAST ORANGE NJ 07017 DEBARMENT 10/14/2000 OZERY, TZIPORA AKA 2/1/1969 27 FIRETOWER ROAD BUDD LAKE NJ 07828 DEBARMENT 9/15/2017 MONICA MOORE PABBATHI, RAMMOHAN 11/25/1946 3 AMY COURT HOWELL NJ 07731 DEBARMENT 7/8/2005 PACHECO, ALVARO R. 59 EDGEHILL COURT WEST ORANGE NJ 07052 DISQUALIFICATION 6/1/1993

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PACHECO, MICHAEL PHARM 9/2/1975 84 LAFAYETTE AVENUE PASSAIC NJ 07055 DEBARMENT 7/18/2003 TECH PADUANO JR., FRANCIS P. RPH 10/15/1947 2020 BALMORAL AVENUE UNION NJ 07735 DISQUALIFICATION 9/16/1986 PADVA-GERMAN, ANNA DDS 8/21/1962 1043382039 446 DUBLIN PLAZA SECAUCUS NJ 07094 DEBARMENT 12/14/2009 3/24/2021 PADVA-GERMAN, ANNA DDS 8/21/1962 1043382039 446 DUNLIN PLAZA, 446H SECAUCUS NJ 07094 DEBARMENT 10/15/2014 3/24/2021 PAGANO, NICOLE RN 4/5/1973 531 PARKWAY AVENUE TRENTON NJ 08618 DISQUALIFICATION 5/20/2009 PAGONZAGA, GLORIA CHHA 12/20/1950 313 OLD BERGEN ROAD, APT. JERSEY CITY NJ 07305 DISQUALIFICATION 2/20/2017 2 PAKETT, NEIL DMD 7/18/1950 1184934663 777 WEST GERMANTOWN PLYMOUTH MEETING PA 19462 DISQUALIFICATION 11/20/2015 PIKE, APT. 530 PALMER, AMANDA LPN 3/24/1983 14 E. MAIN STREET, APT. 4 CLINTON NJ 08809 DISQUALIFICATION 3/13/2019 PALMER, THOMAS RN 5/31/1975 1912200932 FPC PENSACOLA, PO BOX PENSACOLA FL 32516 DISQUALIFICATION 9/29/2017 #14570-003 3949 PAMIDIMUKKALA, VIJAY RPH 8/14/1951 1598087272 3 PENROSE COURT EDISON NJ 08820 SUSPENSION 9/13/1999 PANCELLI, JOHN M. MD 11/26/1961 WEST JERSEY HOSPITAL CAMDEN NJ 08104 DISQUALIFICATION 12/1/1998 DECEASED PANGANIBAN, ARMANDO RN 1/5/1953 CYPRESS ROAD TOMS RIVER NJ 08753 DISQUALIFICATION 8/11/2007

PANICHELLA, ANTHONY COUNSE 1/16/1955 739 S. WHITE HORSE PIKE AUDUBON NJ 08106 SUSPENSION 7/20/2006 PANITCH, EDWIN RPH 1/1/1931 8 POINT OF WOODS DRIVE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 6/1/1993

PANJWANI, HARRY K. MD 6/1/1927 EAST 42 FAIRVIEW TERRACE PARAMUS NJ 07652 DEBARMENT 5/24/1999

PANOS, SPYROS MD 9/30/1968 1497753149 USP CANAAN, PO BOX 300 WAYMART PA 18472 DISQUALIFICATION 11/20/2015 PAPPALARDO, PETER S. MD 6/27/1937 4 SOUTH AIRMONT ROAD SUFFERN NY 10901 DISQUALIFICATION 6/1/1993 #69361-054 PARADISO, NINO RPH 8/20/1943 57 POPLAR DRIVE MORRIS PLAINS NJ 07950 DISQUALIFICATION 9/9/2016 PARCHMENT, ALFRED MD 12/31/1962 1073587242 1140 BURT TAVERN ROAD BRICK NJ 08724 DISQUALIFICATION 10/25/2016 PAREKH, CHANDRAKANT DDS 6/30/1948 1144386178 6529 GERMANTOWN PHILADELPHIA PA 19119 DISQUALIFICATION 11/20/2015 AVENUE PARIDA, SAROJ K. MD 10/21/1959 1013975549 USP LEWISBURG-PO BOX LEWISBURG PA 17837 DISQUALIFICATION 8/20/2013 1000 PARIKH, BIPIN J. MD 8/4/1945 1962555193 224 LAFAYETTE STREET WILLISTON PARK NY 11596 SUSPENSION 11/20/2010

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PARIKH, BIPIN J. MD 8/4/1945 1962555193 224 SOUTH LAFAYETTE WILLISTON PARK NY 11596 SUSPENSION 7/9/2008 STREET PARIKH, MANUPRASAD RPH 6/23/1941 209 STOKES FARM ROAD FRANKLIN LAKES NJ 07417 SUSPENSION 7/20/2004 9/5/2017 PARK MEDICAL 298 CLAIRMONT AVENUE MONTCLAIR NJ 07042 DISQUALIFICATION 8/20/1976 LABORATORY PARKOFF, MICHAEL A. DMD 9/3/1948 68 MAPLEWOOD SUFFERIN NY 10901 DISQUALIFICATION 8/7/1984 BOULEVARD PARTNERS FOR HOPE, PC 1689883001 365 RIFLE CAMP ROAD, WOODLAND PARK NJ 07424 DISQUALIFICATION 1/17/2019 4/24/2019 SUITE 201 PASCUCCI, LAVERNE CHHA 7/5/1946 160 JAMES STREET TOMS RIVER NJ 08753 DISQUALIFICATION 2/8/2017 PATANKAR, SANJIV MD 5/9/1958 1255429361 61 HARDWICK DRIVE KENDALL PARK NJ 08824 DEBARMENT 12/19/2017 PATEL, ARUNA S. MD 11/1/1944 1770568610 725 NORTH BROAD STREET ELIZABETH NJ 07208 DISQUALIFICATION 6/26/2008 PATEL, ASHOKKUMAR R. 5/14/1961 11 YARDLEY STREET EDISON NJ 08820 DISQUALIFICATION 8/10/2007 PATEL, BELA RPH 8/15/1979 1701 COTTMAN AVENUE PHILADELPHIA PA 19111 DISQUALIFICATION 4/9/2015 PATEL, BHARAT KUMAR RPH 7/15/1966 1962729731 140 RIVERSIDE BOULEVARD NEW YORK NY 10069 DISQUALIFICATION 4/20/2014

PATEL, CHANDRAKANT 40 GALESI DRIVE WAYNE NJ 07470 SUSPENSION 3/28/2000 12/12/2007 PATEL, CHIRAG J. 9/22/1975 16 SNEIDER ROAD WARREN NJ 07059 SUSPENSION 4/2/2012 PATEL, CHIRAG J. 9/22/1975 16 SNEIDER ROAD WARREN NJ 07059 DISQUALIFICATION 4/20/2015 PATEL, DINESH R. MD 3/6/1954 1285702829 3 BRIGHTON COURT LIVINGSTON NJ 07039 SUSPENSION 3/17/2012 PATEL, DINESH R. MD 3/6/1954 1285702829 835 CLINTON AVENUE NEWARK NJ 07108 DISQUALIFICATION 2/20/2014 PATEL, DINESH R. MD 3/6/1954 1285702829 3 BRIGHTON COURT LIVINGSTON NJ 07039 DISQUALIFICATION 9/27/2017 PATEL, HARISH AKA MD 3/13/1965 GB-46 PO BOX 26010 BEAUMONT TX 77720 SUSPENSION 11/20/2006 HARRIS, PAUL PATEL, MAHESH I. MD 10/26/1949 1942202841 3 PINE VALLEY WAY FLORHAM NJ 07932 DISQUALIFICATION 1/26/2015 11/9/2020 PATEL, MEHMOOD M. MD 5/25/1945 1225074859 201 MIDDLETON ROAD LAFAYETTE LA 70503 DISQUALIFICATION 2/26/2010 PATEL, PARESH R. DMD 6/7/1965 1134106511 295 MAIN STREET METUCHEN NJ 08840 DISQUALIFICATION 5/22/2014 PATEL, PARESHCHANDRA MD 8/24/1960 1306073200/ 8 NOTTINGHAM ROAD EDISON NJ 08820 DEBARMENT 11/21/2016 C. 1497732994 PATEL, PRAVIN, K. MD 5/17/1957 904 #35 IVY RIDGE ROAD SYRACUSE NY 13210 SUSPENSION 12/19/2002 PATEL, RAMBEN LPN 7/31/1953 505 WEST MINISTER PARLIN NJ 08859 SUSPENSION 8/20/2000 DAHYABHAI BOULEVARD

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PATEL, RAMESH SHANKER RN 8/15/1959 PO BOX 5564 OLD BRIDGE NJ 08857 SUSPENSION 6/20/2001 BHAI PATEL, RITA RPH 6/2/1965 4 HAUSER LANE MATAWAN NJ 07747 SUSPENSION 3/10/2016 2/17/2017 PATEL, RITA RPH 6/2/1965 4 HAUSER LANE MATAWAN NJ 07747 DEBARMENT 3/20/2017 10/19/2017 PATEL, RITA RPH 6/2/1965 4 HAUSER LANE MATAWAN NJ 07747 DISQUALIFICATION 10/19/2017 PATEL, SANJAY I. RPH 6/4/1965 1316335961 63 HEATHERDELL ROAD ARDSLEY NY 10502 DEBARMENT 4/26/2016 PATEL, SANJAY I. RPH 6/4/1965 1316335961 63 HEATHERDELL ROAD ARDSLEY NY 10502 SUSPENSION 4/20/2006 PATEL, SHIRJAY CHHA 6/12/1993 703 NEW DOVER ROAD EDISON NJ 08820 DISQUALIFICATION 2/20/2017 PATEL, VIJAY 1/1/1957 65 W. LINCOLN AVENUE ROCKAWAY NJ 07866 DISQUALIFICATION 11/20/2017 PATEL, VITTHAL I. RPH 5/31/1954 ST. GEORGE AVENUE, APT. AVENEL NJ 07001 SUSPENSION 9/20/2004 141 PATHAK, VINEETA MD 12/16/1963 1104922939 533 LEAWOOD AVENUE TOMS RIVER NJ 08755 DISQUALIFICATION 10/29/2019 PATHARKAR, MANOJ MD 4/13/1971 1598808339 16 LINDA COURT LAURENCE HARBOR NJ 08879 DISQUALIFICATION 12/19/2016 PERMANENT PATIN, YURY MD 9/8/1956 1548325400 45 BEVERLY ROAD SUMMIT NJ 07901 DISQUALIFICATION 2/26/2009 PATTERSON JR., ARTHUR DC 5/2/1958 1164628822 8 FELLOWSWOOD WAY HOLMDEL NJ 07733 DEBARMENT 7/18/2014

PATTERSON, KELEE RN 3/3/1986 577 EAST ROAD BELFORD NJ 07718 DISQUALIFICATION 6/28/2017 PAUL, DAVID M. MD 5/6/1948 1124355250 434 RAHWAY AVENUE WOODBRIDGE NJ 07095 DEBARMENT 3/22/2002 PAYANO, VIANNE AKA CHHA 10/2/1982 710 EAST 18TH STREET PATERSON NJ 07501 DISQUALIFICATION 1/31/2017 AMPARA, VIANNE PEACOCK, DENISE RN 9/8/1978 9331 GLENLOCH STREET PHILADELPHIA PA 19114 DISQUALIFICATION 11/20/2015 PEARSON, KATIE LPN 6/19/1981 229 SNOOKS HILL ROAD LEWISTOWN PA 17044 DISQUALIFICATION 11/20/2015 PEARSON, SHAMERA CHHA 5/1/1990 2824 N. BAMBREY STREET PHILADELPHIA PA 19132 DISQUALIFICATION 7/16/2019 PERMANENT PEART, HAROLD G. LCSW 8/31/1932 3 HARRISON PARK LANE BURLINGTON NJ 08016 SUSPENSION 3/17/2000 PEART, HAROLD G. LCSW 8/31/1932 415 KEIM BOULEVARD BURLINGTON NJ 08016 SUSPENSION 8/20/1999 PECK, MARVIN RPH 5/18/1937 335 GEORGE STREET NEW BRUNSWICK NJ 08901 DISQUALIFICATION 6/1/1993 PELLEGRINO, TAMMY RN 8/20/1964 2423 SHADY LANE, APT. P ATCO NJ 08004 SUSPENSION 2/20/2003 PELLICANO, PAUL J. MD 6/25/1939 1316282783 120 MILLBURN AVENUE, STE. MILLBURN NJ 07041 DISQUALIFICATION 12/1/1998 M1 PEMBERTON, COLIN MD 5/6/1975 1891935557 500 ORANGE STREET NEWARK NJ 07107 DISQUALIFICATION 8/28/2017 4/26/2018 PEMBERTON, COLIN MD 5/6/1975 1891935557 2 DEVONSHIRE TERRACE WEST ORANGE NJ 07052 DISQUALIFICATION 10/8/2019 PENA, CARMEN F. DDS 8/29/1961 1871750166 800 76TH STREET, 2ND NORTH BERGEN NJ 07047 SUSPENSION 9/20/2000 9/15/2015 FLOOR

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PENALES, AMANDO D. 7/30/1973 BAYSIDE STATE PRISON, PO LEESBURG NJ 08327 DISQUALIFICATION 5/9/2014 BOX F-1 PENALVER, FAITH RN 10/5/1943 4 MAPLE COURT ROOSEVELT NJ 08555 SUSPENSION 5/19/2005 PENFIELD, JOHN DO 9/18/1967 1528078839 25 POCONO ROAD DENVILLE NJ 07834 DEBARMENT 3/6/2014 3/2/2018 PENFIELD, JOHN DO 9/18/1967 1528078839 308 MURRAY HILL ROAD VESTAL NY 13850 DISQUALIFICATION 11/20/2015 3/2/2018 PENICO, PETER MD 10/25/1915 300 MAIN STREET MILLVILLE NJ 08332 DISQUALIFICATION 8/24/1978 DECEASED PENNANT GRAY, SONIA CHHA 4/27/1973 491 PARK AVENUE EAST ORANGE NJ 07017 DISQUALIFICATION 7/26/2019 PERMANENT PEOPLE CHOICE HOME 1851416069 430 MORRIS AVENUE ELIZABETH NJ 07208 DISQUALIFICATION 5/24/2017 CARE PEPE, ANTHONY 8/18/1977 111 E. MIAMI AVENUE CHERRY HILL NJ 08034 DEBARMENT 7/1/2019 PERERA, SANTUSHT MD 9/29/1961 1942311147 7 GREENHILL ROAD KINNELON NJ 07405 DISQUALIFICATION 12/22/2016 PERMANENT PEREZ, JORGE MD 9/24/1944 213 14TH STREET PALISADES PARK NJ 07650 SUSPENSION 3/18/2004 PEREZ, JUANA CHHA 4/18/1963 510 25TH STREET UNION CITY NJ 07087 DISQUALIFICATION 2/20/2017 PERLMAN, BERNARD MD 9/8/1952 1477579456 42 OAKMONT ROAD YARMOUTH PORT MA 02675 DEBARMENT 1/3/2000 9/12/2017 PERRIN, DOUGLAS M. CHHA 4/18/1968 1801 LAURAL ROAD LINDENWOLD NJ 08021 SUSPENSION 5/20/2002 PERRY, ELSWETTA CHHA 9/20/1955 291 NORTH PARK STREET, EAST ORANGE NJ 07017 DISQUALIFICATION 3/12/2018 1ST FLOOR PESCIOTTA, BARBARA RPH 10/9/1966 992 VAUGHN AVENUE TOMS RIVER NJ 08753 DEBARMENT 5/18/2006 PESCIOTTA, ROY THOMAS RPH 5/29/1967 992 VAUGHN AVENUE TOMS RIVER NJ 08753 DEBARMENT 5/18/2006 PETERS, MEAGHAN RN 8/25/1980 707 BUCHANAN STREET, APT. TOMS RIVER NJ 08753 DISQUALIFICATION 6/29/2019 2 PETERSEN, PETHINA CHHA 1/23/1955 289 MLK DRIVE JERSEY CITY NJ 07305 SUSPENSION 5/20/2004 PETIT, MADELINE CNA 2/13/1951 228 70TH STREET, 2ND FL. GUTTENBERG NJ 07093 DISQUALIFICATION 7/7/2008 PETRUCELLI, SALVATORE MD 2/22/1950 201 LYONS AVENUE NEWARK NJ 07112 DEBARMENT 2/2/2000

PETTERSEN, LINDA A. RN 5/8/1955 700 PARK BOULEVARD CHERRY HILL NJ 08002 SUSPENSION 10/20/2002 PFAUTZ, JOANNA LPN 10/17/1973 1595 BREAKERS DRIVE, #A MANAHAWKIN NJ 08050 DISQUALIFICATION 5/2/2018 PHARES, ALYSSA RN 7/25/1971 21 WOODLAND WAY DAYTON NJ 08810 SUSPENSION 9/19/2002 PHILEMON, MENAHEM CHHA 1/1/1980 265 KING VILLAGE BUDD LAKE NJ 07869 DISQUALIFICATION 5/18/2018 PHILIPPE, ADELINE CHHA 1/30/1967 61 CLEVELAND STREET, APT. ORANGE NJ 07050 DISQUALIFICATION 3/12/2018 2E PHILIPPE, IRLANDE RN 4/16/1966 29 ELM STREET WEST ORANGE NJ 07052 DISQUALIFICATION 7/22/2017 PHILLIPS, RONALD DO 12/17/1944 718 HAVEN PLACE LINDEN NJ 07026 DEBARMENT 1/8/1999 PHIPPS JR., ERNEST MD 11/6/1963 130 FORD ROAD HOWELL NJ 07731 SUSPENSION 5/20/2004

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PIACENTILE, JOSEPH MD 4/3/1956 1265607410 578 BIG OAK ROAD YARDLEY PA 19067 DISQUALIFICATION 12/17/1995 PIAZZA, GARY G. DO 3/28/1952 7 CARRIAGE PLACE EDISON NJ 08820 DISQUALIFICATION 10/20/1998 PICARIELLO, JOSEPH 12/18/1954 1202 FOX CHASE LANE WHIPPANY NJ 08981 DISQUALIFICATION 6/9/2000 6/1/2016 PIERCE, JACQUELINE CHHA 4/2/1986 1066 NORTH 28TH STREET CAMDEN NJ 08105 DEBARMENT 7/14/2017 PIERCE, LESLIE CHHA 3/31/1968 511 1ST AVENUE, APT. #3-W ASBURY PARK NJ 07712 DEBARMENT 3/6/2018

PIERRE, OTILIEN CHHA 2/10/1972 454 SOUTH OLDEN AVENUE TRENTON NJ 08609 DISQUALIFICATION 2/20/2017

PIERSON, GEORGE T. DO 9/1/1929 5 RAINBOW TRAIL SPARTA NJ 07871 DISQUALIFICATION 4/2/1988 DECEASED PIMPONG, SWANZYBELLA LPN/RN/ 9/3/1975 14 3RD STREET, FLOOR 1 NEWARK NJ 07107 DISQUALIFICATION 3/3/2017 CHHA PINEDA, FRANCESCA RN 3/9/1950 151 TRAILS END NEW CITY NY 10956 SUSPENSION 10/18/2001 PINKERTON, MARIAN LPN 6/20/1957 410 THOMAS AVENUE RIVERTON NJ 08077 SUSPENSION 9/19/2003 PINNAMARAJU, VENKATA RPH 5/23/1977 5234 FOX RIDGE ROAD ROANOKE VA 24018 DISQUALIFICATION 5/24/2017

PIOTROWSKI, DENISE CHHA 4/24/1971 100 EAST MAIN STREET MARLTON NJ 08053 DEBARMENT 7/31/2017 PIRLAMARLA, JYOTI MD 12/30/1950 1952349425 77 JACKSON MILLS ROAD FREEHOLD NJ 07728 DISQUALIFICATION 9/21/2016 PIRMISASHVILI, TEA CHHA 8/16/1976 43 LINDEN STREET FORDS NJ 08863 DISQUALIFICATION 2/20/2017 PIROVOLOS, NICHOLAS RPH 1/10/1930 30 DWIGHT DRIVE WEST DEAL NJ 07712 DISQUALIFICATION 9/16/2000 PIROVOLOS, NICHOLAS RPH 1/10/1930 30 DWIGHT DRIVE OCEAN NJ 07712 SUSPENSION 10/20/2002 PISANI, LOUIS RPH 7/19/1951 1215250709 2 E. FRANKLIN COURT GARDEN CITY NY 11530 SUSPENSION 10/19/2000 PISANI, LOUIS RPH 7/19/1951 1215250709 PO BOX 737513 ELMHURST NY 11373 DISQUALIFICATION 6/3/2016 PIUCK, CHARLOTTE L. MD 7/22/1922 593 RAMAPO VALLEY ROAD OAKLAND NJ 07436 DISQUALIFICATION 10/25/2001

PIZZARELLI, ANGELA D. 6/19/1981 1111 BOND STREET ASBURY PARK NJ 07712 DISQUALIFICATION 7/18/2001 PLANT, CHINIA 1/20/1980 2013 LOGAN STREET HARRISBURG PA 17102 DISQUALIFICATION 11/20/2015 PLINIO, STEVEN DC 5/20/1966 655 AMBOY AVENUE WOODBRIDGE NJ 07095 DEBARMENT 9/30/1999 DECEASED PLOTNIK, PYOTR MD 2/15/1944 1407019813 276 COLERIDGE STREET BROOKLYN NY 11235 DEBARMENT 5/23/2000 PLOTTS, LISA AKA LISA RN 4/15/1976 111 BEECHWOOD AVENUE OAKLYN NJ 08107 SUSPENSION 10/18/2001 FROSCH PLUCINSKI, PATRICIA LPN 8/11/1964 201 HAEGELE PLACE MOUNT ROYAL NJ 08061 SUSPENSION 12/20/2009 POBER, JOSEPH MD 8/29/1953 1194948703 126 LINDEN STREET RIDGEWOOD NJ 07450 DEBARMENT 12/14/2019 POET, ALBERT MD 6/10/1949 1134270903 EAST BAY AVENUE MANAHAWKIN NJ 08050 DISQUALIFICATION 8/10/2007 POFF, SHIABON LPN 7/31/1979 48 CHESTNUT STREET WARETOWN NJ 08758 DISQUALIFICATION 8/22/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE POGGIOLI, STEPHAN 5/11/1963 431 ACADEMY TERRACE LINDEN NJ 07036 SUSPENSION 6/18/2004 POH-EIKOM, VICKI 9/8/1953 619A BILLINGS AVENUE PAULSBORO NJ 08062 DEBARMENT 12/29/1999 POH-EIKOM, VICKI 9/8/1953 619A BILLINGS AVENUE PAULSBORO NJ 08062 DEBARMENT 1/11/2000 POINTE O'WOODS 999 US HIGHWAY ROUTE 9 HOWELL NJ 07731 DISQUALIFICATION 7/11/2000 PHARMACY POLANSKY, IRVING RPH 2/5/1926 260 MAIN STREET KEANSBURG NJ 07734 DISQUALIFICATION 7/9/1985 POLISE, VINCENZO RPH 11/26/1973 33 HARRISON ROAD KINNELON NJ 07405 DEBARMENT 12/31/2015 POLISHUK, ANDRIJ 9/1/1953 649 PULHAM COURT #A MANCHESTER NJ 08759 SUSPENSION 3/8/2008 POLLACK, EARL T. DMD 12/16/1930 171 N. LANSDOWNE AVENUE LANSDOWNE PA 19050 DISQUALIFICATION 11/7/1986

POLLACK, JOSEPH DPM 11/23/1906 PO BOX 11401 YARDVILLE NJ 08628 DISQUALIFICATION 9/30/1982 9/30/1987 POLLEN, PHILIP C. MD 9/1/1954 1245341924 245 ROUTE 9 MORGANVILLE NJ 07751 DEBARMENT 10/28/2013 POOLE, JAMES RN 4/29/1977 1639367972 34 SOUTH 2ND STREET, APT. DEQUESNE PA 15110 DISQUALIFICATION 11/20/2015 5 POOLE, KENDRA CHHA 9/6/1985 222 COOLIDGE AVENUE TRENTON NJ 08618 DISQUALIFICATION 1/23/2018 POPICK, ALAN DO 1/23/1948 1194789214 1532 CREEKSIDE ROAD WHITEHALL PA 18052 DISQUALIFICATION 2/11/2016 POROGER, EMMA DO 5/27/1955 1669572368 59 LINWOOD ROAD STATEN ISLAND NY 10308 DISQUALIFICATION 5/12/2016 POSNER, ROBERT S. DDS 6/21/1957 1740518992 53 WESTFIELD AVENUE CLARK NJ 07066 DISQUALIFICATION 6/23/1999 POTACCO, PHILIP DC 5/6/1952 54 CHURCH STREET SOUTH ORANGE NJ 07079 SUSPENSION 2/20/2003 POTTER, DIANE LPN 4/7/1968 215 FAIRFIELD LANE KING WILLIAM VA 23086 DISQUALIFICATION 5/20/2009 POWELL, WILLIE MFT 2130 MILLBURN AVENUE MAPLEWOOD NJ 07040 DISQUALIFICATION 9/12/2016 PERMANENT PRAVETZ, MICHAEL MD 3/20/1949 531 GATES STREET PHILADELPHIA PA 19128 DEBARMENT 3/5/2001 PRECISE MEDICAL LAB., 1265 PATERSON PLANK SECAUCUS NJ 07094 DISQUALIFICATION 12/1/1998 INC ROAD PRENSKY, JOSHUA DMD 6/19/1976 1578761961 28-10 HIGH STREET FAIRLAWN NJ 07410 DISQUALIFICATION 7/17/2009 PRENSKY, JOSHUA DMD 6/19/1976 1578761961 28-10 HIGH STREET BERGEN NJ 07410 DISQUALIFICATION 5/29/2013 PRESILLA, ALEJANDRO MD 6/11/1948 1902835747 15 FULTON STREET WEEHAWKEN NJ 07086 DEBARMENT 4/30/2010 4/30/2013 PRESS, STUART M. MD 3/29/1952 1525 E. PUTNAM AVENUE OLD GREENWICH CT 06870 DISQUALIFICATION 8/1/2009 #206 PRINTZ, BRUCE I. DO 11/28/1952 400 GILL LANE ISELIN NJ 08830 SUSPENSION 6/6/2004 PRITCHARD, JOSEPH 11/24/1955 69 TALLWOOD DRIVE MEDFORD NJ 08055 SUSPENSION 5/9/2002 12/10/2014 PROSKUROVSKY, BORIS 3/27/1947 218 HALSEY STREET NEWARK NJ 07102 DISQUALIFICATION 8/4/1997 PROSKUROVSKY, BORIS 3/27/1947 218 HALSEY STREET NEWARK NJ 07102 SUSPENSION 8/25/1998 PROTAS, OLEG CHHA 9/6/1987 407 LIBERTY LANE MARLTON NJ 08053 DISQUALIFICATION 7/26/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE PROVOST, LAURIE LPN 2/26/1960 10 BALTIMORE BOULEVARD SEA GIRT NJ 08750 SUSPENSION 1/24/2014

PRZADOWSKA-KOKINDA, RN 6/13/1978 1106 PARKSIDE AVENUE TRENTON NJ 08618 SUSPENSION 4/20/2005 ELIZABETH M. PUCCI, BRIAN M. RPH 4/6/1958 14 RAND ROAD PINE BROOK NJ 07058 SUSPENSION 9/20/2005 9/19/2014 PUENTES, ELENA CHHA 11/28/1960 374B HAMILTON STREET SOMERSET NJ 08873 SUSPENSION 5/14/2007 PUGLIESE, GIROLAMO MD 2/20/1922 103 MAIN STREET KEYPORT NJ 07735 SUSPENSION 2/22/1999 DECEASED PUIG, TAYLOR CHHA 9/23/1994 21 OVERVIEW COURT, APT. BAYVILLE NJ 08721 DISQUALIFICATION 3/16/2021 21 PUIG, TAYLOR PHARM 9/23/1994 21 OVERVIEW COURT, APT. BAYVILLE NJ 08721 DISQUALIFICATION 3/23/2021 TECH 21 PULVIRENTI, FRANCESCA CHHA 4/21/1979 212 8TH STREET SURF CITY NJ 08008 SUSPENSION 9/29/2005 M. PURNESS, TIFFANY CHHA 8/11/1990 105 BLACKWOOD- LINDENWOLD NJ 08021 DISQUALIFICATION 4/26/2018 CLEMONTON ROAD #704 QAYYUM, ABDUL RPH 12/2/1949 960 COUNTRY CLUB DRIVE TEANECK NJ 07666 SUSPENSION 4/27/2000 QUARTARARO, LOUIS MD 1/16/1968 1467460089 37 WEST CENTURY ROAD PARAMUS NJ 07652 DISQUALIFICATION 4/5/2019 QUEEN, RYSHAUN CHHA 5/20/1992 6 KINGSBURY SQUARE, APT TRENTON NJ 08611 DISQUALIFICATION 7/10/2018 #1-D QUEST, BRITTANY CHHA 8/27/1989 379 SANFORD AVENUE NEWARK NJ 07106 DISQUALIFICATION 2/8/2017 QUICK SCRIPT PHARMACY 90 WASHINGTON STREET EAST ORANGE NJ 07017 SUSPENSION 9/22/2000

QUIJADA, CARLOS COUNSE 3/27/1980 106 SPRING VALLEY AVENUE, HACKENSACK NJ 07601 DISQUALIFICATION 12/20/2012 4/9/2019 LOR #1 QUILES, SHALITZA AKA CHHA 10/17/1985 1 WILLIS PLACE, APT. 5 KEANSBURG NJ 07734 DISQUALIFICATION 4/10/2019 SAA, SHALITZA QUINN, JOHN, C. RN 1/19/1959 437 HARRISTOWN ROAD GLEN ROCK NJ 07452 SUSPENSION 6/20/2006 QUINONES, ANEL 11/1/1960 48 GRAND STREET GARFIELD NJ 07026 DISQUALIFICATION 9/11/2001 QUINONES, ELIZABETH CHHA 5/17/1969 210 BOND STREET ELIZABETH NJ 07206 DISQUALIFICATION 2/8/2017 QURESHI, SHAMS MD 4/19/1950 1194743377 1084 MAIN AVENUE CLIFTON NJ 07011 DEBARMENT 1/27/2012 R & M CORPORATION 156 COUNTRY FARM ROAD MARLTON NJ 08053 DISQUALIFICATION RAAB, TERRI A. LPN 7/18/1960 3 MILL ROAD JAMESBURG NJ 08831 SUSPENSION 1/20/2004 RABAH, MOHAMMAD DMD 11/30/1978 1669684114 55 ENCLOSURE STREET NUTLEY NJ 07030 DEBARMENT 3/3/2017 8/23/2019

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE RADICS JR., ALEXANDER LPN 5/17/1961 13 WHITE HAVEN PLACE BLOOMINGDALE NJ 07403 DISQUALIFICATION 4/30/2019 PERMANENT RADOWITZ, MARK A. DC 9/2/1959 76 CHICHESTER ROAD MONROE TOWNSHIP NJ 08831 DISQUALIFICATION 9/4/2007 RAFLA, MAGDY 10/19/1953 3 KULESSA COURT EAST BRUNSWICK NJ 08816 DEBARMENT 8/22/2011 RAHMAN, RONALD MD 5/3/1950 1437378502 20 SUSSEX AVENUE VOORHEES NJ 08043 DISQUALIFICATION 5/29/2013 RAHMAN, SAHID CHHA 1/8/1985 29 ROBIN COURT PISCATAWAY NJ 08854 DISQUALIFICATION 1/29/2018 RAIA, JOSEPH MD 7/11/1959 1225126717 56 GRAFTON AVENUE NEWARK NJ 07104 DEBARMENT 7/28/2014 RAJA, ABDUL H. 8/4/1947 53 FULHAN LANE HOLBROOK NY 11741 DISQUALIFICATION 1/29/2003 RAJU, SRINIVASA RPH 9/5/1971 115 RIVERWALK WAY D2 CLIFTON NJ 07014 DISQUALIFICATION 7/20/2017 RAMACHANDRA, MD 5/1/1952 1235219809 741 ROUTE 18 S. EAST BRUNSWICK NJ 08816 DEBARMENT 4/18/2014 11/5/2018 NANDAVAR RAMACHANDRA, MD 5/1/1952 1235219809 165 SALEM ROAD NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 12/21/2020 NANDAVAR RAMANADHAM, ARUNA MD 1/7/1946 1609157692 9 MOUNTAINVIEW DRIVE LIVINGSTON NJ 07039 DEBARMENT 1/12/2000 RAMAS, EDWIN L. LPN 5/18/1956 789 MITCHEL AVENUE UNION NJ 07083 DEBARMENT 7/17/2009 7/17/2014 RAMIREZ, MARIELA CHHA 5/15/1961 775 EAST 3RD AVENUE, APT. ROSELLE NJ 07203 DEBARMENT 1/9/2018 A RAMOS, JEANETTE CHHA 8/24/1989 234 WILMONT AVENUE CAMDEN NJ 08105 DISQUALIFICATION 5/2/2017 RAMOS, REYNALDO 12/22/1968 52 ABINGTON COURT MAYS LANDING NJ 08330 DEBARMENT 8/12/2013 RAMOS, ROLANDO 5/13/1977 85 SHERMAN AVENUE TEANECK NJ 07666 DISQUALIFICATION 2/20/2004 RAMPERSAD, 8/20/1953 11 APPLETREE LANE LANDING NJ 07850 SUSPENSION 12/20/2000 LAKSHMINARINE RANCOCAS VALLEY 700 ROUTE 130 NORTH CINNAMINSON NJ 08077 SUSPENSION 8/20/2003 ANESTHESIA RAND, DOV MD 2/10/1965 1043311145 667 EAGLE ROCK AVENUE WEST ORANGE NJ 07052 SUSPENSION 2/15/2012 RAND, DOV MD 2/10/1965 1043311145 667 EAGLE ROCK AVENUE WEST ORANGE NJ 07052 DEBARMENT 9/3/2013 RAND, DOV MD 2/10/1965 1043311145 840 STONEWALL COURT FRANKLIN LAKES NJ 07417 DEBARMENT 5/7/2014 RAND, ELIAS 11/5/1932 1401 OCEAN AVENUE BROOKLYN NY 11230 DISQUALIFICATION 6/1/1993 RAO, MALINI MD 4/26/1975 1649456005 444 WASHINGTON JERSEY CITY NJ 07310 DISQUALIFICATION 9/12/2016 BOULEVARD RASCHID, SOHAEL MD 1/12/1957 1104851369 1126 KENNEBEC DRIVE CHAMBERSBURG PA 17201 DISQUALIFICATION 11/20/2015 RASNER, STEVEN DMD 7/15/1954 1114022803 1055 NORTH PEARL STREET BRIDGETON NJ 08401 DISQUALIFICATION 10/16/1984 4/5/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE RASOULINEJAD, ZAHREH DDS PO BOX 1217 ALPINE NJ 07620 SUSPENSION 10/20/2003 T. RATCHFORD, WILLIAM B. MD 2/13/1945 PO BOX 2063 GLENVIEW IL 60025 SUSPENSION 6/4/1998 RAUH - BRIGHAM, SUSAN RN 8/24/1956 4 BRECKENRIDGE DRIVE SHAMONG NJ 08088 SUSPENSION 5/20/2001

RAVAL, KAWU 600 PAVONIA AVENUE JERSEY CITY NJ 07306 SUSPENSION 12/1/1998 RAVIN, JOHN M. MD 7/29/1938 9600 STERLING RIDGE LAS VEGAS NV 89129 SUSPENSION 2/19/2004 AVENUE RAY, DEBRA RN 5/14/1952 32 KAYWIN AVENUE HAWTHORNE NJ 07506 SUSPENSION 2/19/2004 RAYNOR, MARCELLA 8/27/1952 660 BROAD STREET, APT. 811 HARRISBURG PA 17102 DISQUALIFICATION 11/20/2015

RAZIQ, RAFIK 1/1/1960 NORTHERN STATE PRISON NEWARK NJ 07115 DISQUALIFICATION 7/1/2002 REA, MICHAEL MD 444 MANSFIELD AVENUE HADDONFIELD NJ 08033 DEBARMENT 3/11/2001 DECEASED REATH, ERIN R. RN 10/3/1960 7705 SABRE DRIVE KNOXVILLE TN 37919 SUSPENSION 8/18/2005 REAVES, LORI A. MD 12/4/1960 1417959503 ALDERSON FPC, GLEN RAY ALDERSON WV 24910 DISQUALIFICATION 3/7/2014 RD, BOX A REBA, GARY J. DDS 2/17/1947 1285852541 TITUS LANE PLAINSBORO NJ 08536 SUSPENSION 12/20/2007 RECK, FRANZ DDS 1/16/1963 1528248457 17 CENTER STREET HIGHLANDS NJ 07732 DISQUALIFICATION 12/1/2019 7/21/2020 RECOVERY SYSTEMS INC. 476 CLIFTON AVENUE CLIFTON NJ 07011 SUSPENSION 5/8/2003

REDDEN, DAYJA CHHA 8/1/1989 1822 SOUTH 7TH STREET CAMDEN NJ 08104 DISQUALIFICATION 1/23/2018 REDDY, PRANATHI DMD 8/24/1976 1538321583 6207 SPRUCE MILL DRIVE MORRISVILLE PA 19067 DISQUALIFICATION 1/23/2019 7/21/2020 REDNOR, GERALD B. 101 KENSINGTON AVENUE TRENTON NJ 08618 DISQUALIFICATION 6/1/1993 REDONDO, ILEANA MD 6/4/1932 2421 ROSETTE STREET FORT LEE NJ 07024 DISQUALIFICATION 4/23/2002 REED, JUDY 233A MUHAMMAD ALI NEWARK NJ 07108 DISQUALIFICATION 12/15/2005 AVENUE REED, STEPHAN NILS DC 7/14/1942 4722 EAST DELL ROAD PHOENIX AZ 85026 DISQUALIFICATION 6/1/1993 DECEASED REEVES, WILBURN C. CNA 5/19/1971 23 CREEK ROAD BRICK NJ 08724 DISQUALIFICATION 8/10/2007 REFOCUS GROUP, LLC 1306342373 200 ROUND HILL DRIVE FREEHOLD NJ 07728 SUSPENSION 4/29/2019 REGO, RAMON MD 11/13/1961 1033227459 6701 BERGENLINE AVENUE WEST NEW YORK NJ 07093 DEBARMENT 3/19/2012 2/16/2017 REHAN, ZAHEER A. 280 HENDERSON STREET JERSEY CITY NJ 07302 DISQUALIFICATION 5/10/1999 REHMAN, FAROOQ MD 1/25/1954 1467581827 225 MAY STREET, SUITE D-1 EDISON NJ 08837 SUSPENSION 4/20/2016 2/9/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE REHMAN, FAROOQ MD 1/25/1954 1467581827 225 MAY STREET, SUITE D-1 EDISON NJ 08837 DEBARMENT 11/13/2015

REID, PEACHES CNA 11 RUTGERS STREET IRVINGTON NJ 07111 DISQUALIFICATION 4/1/2002 REINHARD, BARBARA 704 REED COURT FLEMINGTON NJ 08822 DISQUALIFICATION 7/9/2007 REINHART, JENNIFER LPN 8/1/1977 70 ROSS AVENUE HACKENSACK NJ 07601 DISQUALIFICATION 11/23/2019 REITER, RAYMOND D. MD 1/21/1955 1841447380 405 MURRAY HILL PARKWAY, EAST RUTHERFORD NJ 07073 DISQUALIFICATION 10/22/2001 #1023 RENNER, ALLISON 1/27/1977 1210 OAK ROAD MANASQUAN NJ 08736 DISQUALIFICATION 3/28/2017 RENNER, CARL MD 3/13/1952 1346205705 61 WALDRON AVENUE GLEN ROCK NJ 07452 DISQUALIFICATION 6/25/2019 PERMANENT RENZI, CAROLINE M. DO 3/4/1922 247 CENTER STREET TRENTON NJ 08611 DISQUALIFICATION 12/4/1991 DECEASED RESTORATION 1385 STUYVESANT AVENUE UNION NJ 07083 DEBARMENT 1/16/2009 1/6/2012 PHARMACY REVAN-LEWIS, CHAUNDEL CHHA 2/6/1981 26 NANCY LANE PISCATAWAY NJ 08854 DISQUALIFICATION 2/8/2017 REYES, BRIANNA CHHA 5/29/1991 220 WEST BRANCH AVENUE, PINE HILL NJ 08021 DISQUALIFICATION 3/5/2019 APT. 111 REYES, DANNIELL DC 4/21/1960 1124053905 5262 HAMILTON S SAYLORSBURG PA 18353 DISQUALIFICATION 11/20/2015 REYES, MARIA CHHA 6/13/1987 1207 ATLANTIC AVENUE CAMDEN NJ 08104 DEBARMENT 8/29/2017 REYES-ARIAS, ARCADIO 1/12/1971 286 SUSSEX AVENUE NEWARK NJ 07107 DISQUALIFICATION 2/11/2016 REZNIKOVA, YELENA CHHA 9/28/1977 73 MADISON GARDENS OLD BRIDGE NJ 08857 DEBARMENT 6/12/2017 RGN PHARMACY 1790840130 22 ELIZABETH AVENUE NEWARK NJ 07108 SUSPENSION 8/17/2007 RHODES, SARE MAE DMD 2/6/1978 1750572996 161 BRIDGE STREET TUNKHANNOCK PA 18657 DISQUALIFICATION 12/29/2015 RIACHI, LABIB MD 9/4/1968 1801846597 319 MASSACHUSETTS WESTFIELD NJ 07090 DISQUALIFICATION 2/9/2017 STREET RIACHI, LABIB MD 9/4/1968 1801846597 42 RUTGERS AVENUE COLONIA NJ 07067 DEBARMENT 2/9/2018 RICCIARDI, JUDE CHHA 12/6/1969 1452 45TH STREET NORTH BERGEN NJ 07047 SUSPENSION 6/20/2002 RICCIO, PETER RPH 4/16/1953 17 CASALE DRIVE, APT. R2 WARREN NJ 07059 DISQUALIFICATION 5/12/2016 RICH, LEO CEDAR LANE TEANECK NJ 07666 DISQUALIFICATION 6/1/1993 RICHARDS, AARON COUSEL 12/14/1962 23 WYCOFF STREET DEAL NJ 07723 SUSPENSION 2/20/2001 RICHARDSON, YALONDA CHHA 7/15/1980 52 2ND AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 2/20/2017 RICHLINE, AMANNDA DPM 5/5/1969 1013040435 4 GREENWICH STREET BELVIDERE NJ 07823 DEBARMENT 7/22/2017 RICHMAN, HOWARD P. DPM 12/31/1951 502 N BLACK HORSE PIKE WILLIAMSTOWN NJ 08053 DISQUALIFICATION 4/15/1993 RICHSTONE, GEOFFREY MD 9/17/1938 PO BOX 38, FCI FORT DIX NJ 08640 SUSPENSION 6/20/2002 RIGGI, JOSEPH MD 8/5/1970 1265436638 36 VARDON WAY FARMINGDALE NJ 07727 DEBARMENT 12/9/2015 4/9/2019

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE RIGO, BLADIMIR 3/22/1940 FCI-FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 5/12/2016

RILEY, BRIDGETT PHARM 1801 EGG HARBOR ROAD LINDENWOLD NJ 08021 SUSPENSION 3/20/2003 TECH RIMERMAN, VALERY MD 4/29/1939 43 DEMAREST AVENUE CLOSTER NJ 07624 SUSPENSION 12/20/2006 DECEASED RIOS, GUSTAVO ERNESTO MD 9/13/1967 1780648295 127 TWEED DRIVE JACKSONVILLE NC 28540 DEBARMENT 10/11/2011 RIOS, JOSE MD 8/22/1927 175 SUMMER AVENUE NEWARK NJ 07104 SUSPENSION 5/14/1998 RIPPS, DANIEL DDS 9/3/1948 1124293659 1330 CALHOUN STREET TRENTON NJ 08618 DISQUALIFICATION 12/1/1995 RIVERA, DAISY CHHA 10/20/1994 329 LINE STREET CAMDEN NJ 08103 DISQUALIFICATION 1/29/2018 RIVERA, JACQUELINE CHHA 6/11/1977 418 12TH STREET, APT. #1 UNION CITY NJ 07087 DISQUALIFICATION 1/23/2018 RIVERA, JOSSELIN 9/14/1979 251 MT. VERNON STREET CAMDEN NJ 08103 DISQUALIFICATION 1/27/2006 RIVERA, KAREN CHHA 9/23/1989 209 NILES STREET, APT. 1 ELIZABETH NJ 07202 DEBARMENT 2/20/2017 RIVERA, MARIA RN 11/1/1948 39 JOHNS WAY BRIDGETON NJ 08302 DISQUALIFICATION 9/30/2019 RIVERA, NICOLE AKA RN 2/11/1983 2009 KICKAPOO TERRACE VINELAND NJ 08361 DISQUALIFICATION 3/28/2017 CRESTA, NICOLE RIVERA, VIVIANIS CHHA 7/5/1984 519 BRUNSWICK AVENUE TRENTON NJ 08638 DISQUALIFICATION 10/20/2017 RIZVI, SAIYID PHD 100 CRAIG ROAD, SUITE 104 MANALAPAN NJ 07726 SUSPENSION 4/18/1997

RIZZO, KENNETH RPH 2/16/1965 110 WELLS FARM ROAD GOSHEN NY 10924 SUSPENSION 5/19/2005 RIZZUTO, MARY F. LCSW 1/24/1960 1851499891 16 HOLLY HILL DRIVE TOMS RIVER NJ 08753 DISQUALIFICATION 4/22/2012 ROBACK, MARY LPN 7/29/1954 2517 DUNKSFERRY ROAD, BENSALEM PA 19020 DISQUALIFICATION 6/20/2018 APT. L203 ROBALINO, JOFFRE MD 6/12/1967 1770634404 PO BOX 1000 CUMBERLAND MD 21501 DISQUALIFICATION 5/28/2013 ROBBERSON JR., 8/17/1969 3404 SHORELINE DRIVE WALL TOWNSHIP NJ 07719 DISQUALIFICATION 6/16/2017 KENNETH ROBBINS, GORDON J. 447 UNION AVENUE PATERSON NJ 07522 DISQUALIFICATION 4/30/1987 ROBBINS, RICHARD G. MD 7/29/1963 551 MILLBURN AVENUE SHORT HILLS NJ 07078 SUSPENSION 2/19/2004 ROBERTS, ELIANE CHHA 9/10/1962 380 PARK AVENUE, APT. C5 ORANGE NJ 07050 DISQUALIFICATION 7/14/2017 ROBERTS, JAMES RN 5/29/1969 235 PENN AVENUE DOVER NJ 07801 DISQUALIFICATION 7/22/2017 ROBERTSON, TANAYE CHHA 8/11/1987 1200 EAST STATE STREET, CAMDEN NJ 08105 DISQUALIFICATION 7/10/2018 APT. 1405 ROBINSON, CHRISTINA CHHA 2/10/1993 81 ABBLETT VILLAGE CAMDEN NJ 08105 DISQUALIFICATION 7/22/2019 ROBINSON, KIM 2/23/1956 594 WALNUT STREET ELIZABETH NJ 07201 SUSPENSION 2/3/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ROBINSON, TRENNAJIA CHHA 2/18/1994 89 FOURTH STREET, APT. #43 PASSAIC NJ 07055 DISQUALIFICATION 5/2/2017

ROBINSON, VINCENT 3/10/1968 62 MAPLE AVENUE IRVINGTON NJ 07111 DEBARMENT 3/13/2009 3/13/2014 ROBINSON, WANDA J. 7/23/1944 150 MELROSE AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 9/4/1986 RODENBERG, THOMAS MD 4/6/1959 1720280183 DESOTO ANNEX, 13617 ARCADIA FL 34266 DISQUALIFICATION 12/29/2015 SOUTHEAST HWY 70 RODRIGUEZ, ARACELY CHHA 4/18/1975 1039 NORTH 35TH STREET CAMDEN NJ 08105 DEBARMENT 5/31/2018 RODRIGUEZ, BEATRIZ 10/8/1967 109 GREENBRIAR AVENUE RICHLAND NJ 08350 SUSPENSION 10/18/2001 BOX 157 RODRIGUEZ, CHRISTIAN CHHA 8/10/1982 2 W. PARK AVENUE PENNS GROVE NJ 08069 DISQUALIFICATION 3/5/2019 RODRIGUEZ, DARIELI CHHA 5/22/1991 545 NEWTON LAKE DRIVE COLLINGSWOOD NJ 08107 DISQUALIFICATION 9/26/2017 RODRIGUEZ, FERNANDO MD 6/10/1950 122 S. MONTFORT DRIVE BELLE MEAD NJ 08502 DEBARMENT 4/6/2004

RODRIGUEZ, JAZMIN CHHA 7/28/1987 214 48TH STREET UNION CITY NJ 07087 DISQUALIFICATION 7/10/2018 RODRIGUEZ, LEONELA CHHA 2/21/1990 1032 N. 21ST STREET CAMDEN NJ 08105 DEBARMENT 7/10/2018 RODRIGUEZ, MELENYS CHHA 6/26/1990 18 WINDING WOOD DRIVE SAYREVILLE NJ 08872 DISQUALIFICATION 8/29/2017 RODRIGUEZ, NICOLE CHHA 10/13/1992 658 DELSEA DRIVE PITMAN NJ 08071 DEBARMENT 4/6/2018 RODRIGUEZ, RAMON R. 1/13/1939 100 MANHATTAN AVENUE JERSEY CITY NJ 07307 DISQUALIFICATION 3/17/1986 DECEASED RODRIGUEZ, RONALD J. LPN 5/20/1966 7 EASTERN LANE WILLINGBORO NJ 08046 SUSPENSION 12/20/2006 RODRIGUEZ, RONALD J. LPN 5/20/1966 7 EASTERN LANE WILLINGBORO NJ 08046 DEBARMENT 7/11/2018 ROGERS, JAMES G. 2/22/1937 49 WESTERN PARKWAY IRVINGTON NJ 07111 SUSPENSION 4/11/2006 ROHAUS, ROBERT 301 LILAC COURT BRIDGEWATER NJ 08807 SUSPENSION 8/25/2000 ROHE, PAUL DPM 11/16/1956 24 FAIRWAY DRIVE GREEN BROOK NJ 08812 SUSPENSION 11/20/2006 ROLON JR., ORLANDO 11/4/1957 1239 DUPONT STREET CAMDEN NJ 08105 DISQUALIFICATION 11/12/2009 ROMANAZZI, THOMAS 612 MYRTLE AVENUE MANASQUAN NJ 08786 DISQUALIFICATION ROMAN-CISSE, DENISE PHARM 12/16/1983 9 SECOND AVENUE NEWARK NJ 07104 DEBARMENT 4/12/2012 ROMANOWSKI, STEVEN PO BOX 1011 UNION NJ 07083 DISQUALIFICATION 6/1/1985 ROMERO, IVAN J. RPH 4/14/1969 1003089343 USP CANAAN, PO BOX 300 WAYMART PA 18472 DISQUALIFICATION 8/8/2011 ROMILLO, JOSE E. MD 3/1/1945 1467544155 954 FISCHER BOULEVARD TOMS RIVER NJ 08753 DISQUALIFICATION 8/16/2011 RONAN, KATHLEEN RN 17 HENRY STREET SAYERVILLE NJ 08872 SUSPENSION 10/18/2001 RONCAL JR., MARIO 4/2/1951 901 RIFLE CAMP ROAD WOODLAND PARK NJ 07424 DISQUALIFICATION 8/20/2014 RONE, FELICIA CHHA 3/19/1978 2702 SHETLAND WAY WESTVILLE NJ 08093 DISQUALIFICATION 7/14/2017 ROQUE, JOSE RAMON MD 317 60TH STREET WEST NEW YORK NJ 07903 DISQUALIFICATION 8/1/1996

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ROSA, EDDIE MD 3/3/1966 1215045869 796 MOUNT PROSPECT NEWARK NJ 07104 SUSPENSION 2/15/2012 AVENUE ROSA, EDDIE MD 3/3/1966 1215045869 117-119 THIRD AVENUE 2 NEWARK NJ 07104 DISQUALIFICATION 1/26/2015 ROSA, EDDIE MD 3/3/1966 1215045869 117-119 THIRD AVENUE NEWARK NJ 07104 DEBARMENT 11/21/2016 ROSA, EDDIE MD 3/3/1966 1215045869 796 MOUNT PROSPECT NEWARK NJ 07104 DISQUALIFICATION 9/17/2013 AVENUE ROSADO, EDITH CHHA 10/29/1968 326 GREGORY AVENUE PASSAIC NJ 07055 DISQUALIFICATION 2/8/2017 ROSANIA, NICHOLAS G. DC 5/28/1968 1 COBBLESTONE LANE LONG VALLEY NJ 07853 SUSPENSION 10/20/2003 ROSARIO, JASON CHHA 2/10/1993 133 RUTGERS PLACE NUTLEY NJ 07110 DEBARMENT 11/1/2017 ROSE, RADCLIFFE RN/PHA 8/10/1965 99 GROVE AVENUE MAYWOOD NJ 07607 DISQUALIFICATION 2/21/2018 PERMANENT RM TECH

ROSEN, BURTON DDS 9/22/1930 1939 ROUTE 70 EAST CHERRY HILL NJ 08003 DEBARMENT 5/24/1999 ROSEN, JAY MD 11/30/1946 1720139736 3 HIDDEN ACRES DRIVE VOORHEES NJ 08043 DISQUALIFICATION 8/22/2016 PERMANENT ROSENBERG, MARK RN/APN 4/3/1954 1407829096 19 BRANDYWINE DRIVE MARLTON NJ 08052 DISQUALIFICATION 11/21/2016 ROSENBLIT, ERIN RN/APN 8/17/1955 654 8TH STREET ABSECON NJ 08201 DEBARMENT 6/5/2018 ROSENFARB, ANDREW ACCUPU 1/12/1972 332 SOUTH AVENUE EAST WESTFIELD NJ 07090 SUSPENSION 3/20/2005 NCTURIS T ROSENSWEET, MARTIN DPM 6/27/1957 FORT DIX FCI, PO BOX 38 JOINT BASE MDL NJ 08640 DEBARMENT 7/18/2002 ROSERO, BENITO MD 11/18/1937 107 E. MANTUA AVENUE WEHONAH NJ 08090 SUSPENSION 2/2/1998 ROSERO, BENITO MD 11/18/1937 109 AMBLER ROAD CHERRY HILL NJ 08002 SUSPENSION 1/6/1999 ROSS, BERNARD MD 5/8/1914 30 E. PASSAIC STREET MAYWOOD NJ 07607 DEBARMENT 10/5/1999 ROSS, DOUGLAS AKA 12/10/1972 123 N. 19TH STREET EAST ORANGE NJ 07017 DISQUALIFICATION 10/14/2005 SHAW, RICKY ROSS, JONATHAN MD 4/1/1954 11 TEAK COURT CHERRY HILL NJ 08003 DISQUALIFICATION 6/19/2000 ROSS, JOSIE B. RN 6/27/1955 25 GRAND AVENUE HACKENSACK NJ 07601 SUSPENSION 7/20/2004 ROSS, RUBY LPN 10/15/1964 149 RIDGE AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 12/5/2017 ROSSI, ANGELA LPN 12/18/1976 813 HAZELTON AVENUE LANOKA HARBOR NJ 08734 DISQUALIFICATION 6/5/2017 ROSSNICK, GERALD DDS 1/29/1923 868 BROADWAY BAYONNE NJ 07002 DISQUALIFICATION 12/1/1988 ROTHENBERG, HOWARD DMD 4/14/1951 1437223898 11 OAK SPRING ROAD WEST NYACK NY 10994 DISQUALIFICATION 12/29/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ROTHSTEIN, JEFFREY DMD 12/4/1964 1366677544 326 BROAD STREET, SUITE 1 RED BANK NJ 07701 DISQUALIFICATION 7/20/2017 9/22/2017

ROTWEIN, PAUL S. DDS 6/24/1957 220 E. 63RD STREET, APT. 8F NEW YORK NY 10021 DEBARMENT 4/20/2003

ROUNTSEV, ANATOLI CHHA 3/25/1962 409 RIVERVIEW DRIVE TOTOWA NJ 07512 SUSPENSION 11/4/2014 ROUNTSEV, ANATOLI CHHA 3/25/1962 406 RIVERVIEW DRIVE TOTOWA NJ 07512 DISQUALIFICATION 2/11/2016 ROUSE, JODY LPN 9/2/1977 189 BROWNIES ROAD SHIPPENVILLE PA 16254 DISQUALIFICATION 11/20/2015 ROUSSIS, NICHOLAS MD 6/29/1968 1497749089 4735 HYLAN BOULEVARD STATEN ISLAND NY 10312 DEBARMENT 7/1/2017 ROWE, ELIZABETH LPN 4/10/1982 6 WINDING WOOD DRIVE, SAYREVILLE NJ 08872 DEBARMENT 6/28/2018 APT. 1B ROYSTER, TAHNESHA CHHA 4/15/1988 30 RIDGE AVENUE NEPTUNE NJ 07753 DEBARMENT 8/24/2017 ROZO, GLADYS 374B HAMILTON STREET SOMERSET NJ 08873 SUSPENSION 5/14/2007 ROZVAGA, NADEZHDA 11/4/1946 155 ALEXAUKEN CREEK LAMBERTVILLE NJ 08530 SUSPENSION 8/20/2009 ROAD RUANE, JOSEPH T. DC 8/16/1955 314 WILLOW DRIVE LITTLE SILVER NJ 07739 SUSPENSION 1/8/1997 RUBBANI, MARIAM MD 2/28/1972 1801939723 280 SOUTH HARRISON EAST ORANGE NJ 07017 DISQUALIFICATION 9/12/2018 STREET RUBINSTEIN, CHARLES RPH 45 LAUREL AVENUE LINWOOD NJ 08221 SUSPENSION 8/20/2006 RUCHELMAN, TRINA DDS 1/19/1973 1356425474 2120 ROUTE 70 MANCHESTER NJ 08759 DISQUALIFICATION 5/20/2019 RUDOLPH, HERBERT MD 11/9/1954 1871633370 317 EAST MAIN STREET TUCKERTON NJ 08087 DEBARMENT 9/14/2016 2/19/2020 RUFFIN, SHARALYN CHHA 12/12/1980 OAKDALE VILLAGE TRAILER CRANBURY NJ 08512 DISQUALIFICATION 2/8/2017 #52 RUGGIERO, PAULA E. RN 12/8/1970 29 PARKWAY DRIVE WESTVILLE NJ 08093 SUSPENSION 10/18/2001 RUIZ, DORIS 909 WEST 7TH STREET PLAINFIELD NJ 07063 SUSPENSION 5/14/2007 RUIZ, JENNIFER 4/14/1983 38 S. BRIDGEBORO STREET DELRAN NJ 08075 DISQUALIFICATION 11/21/2016 RULDAN, THOMAS LPN 301 OHIO AVENUE PHILLIPSBURG NJ 08865 SUSPENSION 5/20/2001 RUMMA, CHRISTINE 164 STARBOARD STREET FORKED RIVER NJ 08731 DISQUALIFICATION 5/26/2000 RUSH, DALE LPN 6/20/1962 182 PRESTON ROAD, APT. H2 MILFORD NJ 08848 DISQUALIFICATION 3/11/2019

RUSH, DAVID A. 6/25/1959 5755 PFEIFER CIRCLE GERMANSVILLE PA 18053 SUSPENSION 4/19/1999 RUSH, DAVID A. 6/25/1959 5755 PFEIFER CIRCLE GERMANSVILLE PA 18053 DISQUALIFICATION 10/11/2000 RUSHING, GARY DC 5/20/1959 1538315478 70 BROAD STREET, SUITE B MATAWAN NJ 07747 SUSPENSION 1/20/2002

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE RUSSELL JR., BERTRAM R. MD USP HAZELTON, PO BOX BRUCETON MILLS WV 26525 DEBARMENT 12/28/2014 2000 RUSSELL, FERNESE D. CNA 666 E. 26TH STREET PATERSON NJ 07504 DEBARMENT 3/24/2002 RUSSELL, ROBERT J. DC 3/26/1962 1645 B-BLACKWOOD BLACKWOOD NJ 08012 DISQUALIFICATION 10/2/1995 CLEMENTON ROAD RUSSO, GRACE RN 5/4/1960 17 MAPLE PLACE KEYPORT NJ 07735 DISQUALIFICATION 9/30/2019 RUSSOMANNO, MD 5/30/1943 1093702532 350 BLOOMFIELD AVENUE BLOOMFIELD NJ 07003 DEBARMENT 11/28/2007 RAYMOND RUTA, EUGENIO DC 4/14/1961 189 6TH AVENUE LONG BRANCH NJ 07740 SUSPENSION 7/21/2008 RUTIGLIANO, MICHAEL MD 3/23/1962 1740348077 1 SEARS DRIVE PARAMUS NJ 07652 DISQUALIFICATION 9/19/2016 RX 2000 PHARMACY, INC. 2125A KENNEDY BOULEVARD JERSEY CITY NJ 07305 DISQUALIFICATION 1/2/2000

RYAN, GERALDINE RN 2/5/1956 228 RIDGE AVENUE LAKEWOOD NJ 08701 SUSPENSION 2/20/2002 RYAN, JAMES 267 SEACLIFF AVENUE SEACLIFF NY 11579 DISQUALIFICATION 4/1/1996 4/1/2004 RYAN, MICHELE K. LPN 7/25/1969 656 WHITE HORSE PIKE HAMMONTON NJ 08037 SUSPENSION 3/20/2002 RYBALOV, SEMEN CHHA 11/5/1945 BERGEN COUNTY JAIL, PO HACKENSACK NJ 07601 DISQUALIFICATION 10/28/2015 BOX 0369 RYTEL, SYLVIA LPN 5/1/1983 634 INDIANA AVENUE TRENTON NJ 08638 DISQUALIFICATION 8/3/2019 S. RESES APOTHOCARY 6522 VENTNOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION SAA, SHALITZA AKA CHHA 10/17/1985 1 WILLIS PLACE, APT. 5 KEANSBURG NJ 07734 DISQUALIFICATION 4/10/2019 QUILES, SHALITZA SAADY, JACK R. RPH 7/18/1960 281 ROUND HILL DRIVE FREEHOLD NJ 07728 DISQUALIFICATION 7/11/2000 SABA - KHALIL, ROSALY MD 10/10/1939 531 SUMMIT AVENUE FRANKLIN LAKES NJ 07417 DISQUALIFICATION 7/10/1995 SABATE, NEONITA RN 6/3/1956 PO BOX 4004 CLINTON NJ 08809 DISQUALIFICATION 8/27/2001 SABBAGHZADEH, 9/29/1981 108 BRANDON ROAD EAST SYRACUSE NY 13057 SUSPENSION 3/20/2012 ANDREW A. SABIDO, BENJAMIN A. MD 3/30/1952 1720159916 805 11TH STREET UNION CITY NJ 07087 DISQUALIFICATION 3/26/2015 SACCA, COLLEEN RN 11/11/1969 310 GARFIELD AVENUE PALMYRA NJ 08065 SUSPENSION 5/20/2004 SACHER, PHILIP 558 ANDERSON AVENUE CLIFFSIDE PARK NJ 07010 DISQUALIFICATION 5/6/1986 SADARANGANI, MD 7/12/1945 1386790665 240 LYNCREST ROAD ENGLEWOOD CLIFF NJ 07632 DISQUALIFICATION 2/28/2011 SADLER, RUFUS MD 3/13/1956 1316935406 2 LAWRENCE STREET MOUNT VERNON NY 10552 DISQUALIFICATION 6/3/2016 SAEED, MOHAMMED PHARM 1507 FINNEGANS LANE NEW BRUNSWICK NJ 08902 DISQUALIFICATION 11/16/1998 OWNER

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SAFIER, GARY DO 2/21/1943 1558478529 8 QUARRY COURT, #3 RANDOLPH NJ 07869 DEBARMENT 4/1/2016 SALAAM, ABDUL J. MD 1153 SOUTH ORANGE NEWARK NJ 07103 DISQUALIFICATION 8/7/1997 AVENUE SALAGA, JENNIFER RN 3/29/1981 248 WARD AVENUE BORDENTOWN NJ 08505 DISQUALIFICATION 6/28/2017 SALAMI, ADEMOLA T. HARVARD AVENUE HILLSIDE NJ 07205 DISQUALIFICATION 9/15/2008 SALARTASH, KHASHAYAR MD 8/11/1966 1457376006 112 POND LANE LINWOOD NJ 08221 SUSPENSION 10/27/2009 10/7/2011

SALEMA, JOSEPH 4/25/1948 101 EAST ELM STREET WENONAH NJ 08090 DISQUALIFICATION 4/4/1998 SALITA, CONRAD C. MD 4/27/1932 1 N. VALLEY AVENUE VINELAND NJ 08360 DISQUALIFICATION 12/29/1995 SALKIND, SCOTT A. DO 8/10/1953 1750401949 611 KINGS CROFT CHERRY HILL NJ 08034 SUSPENSION 9/14/2000 SALOMONE, JOSEPH DC 3/11/1968 1609019140 156 FRANKLIN AVENUE NUTLEY NJ 07110 DISQUALIFICATION 7/20/2015 SALT & PEPPER INC. 24 BRANFORD PLACE NEWARK NJ 07102 DISQUALIFICATION 5/9/1994 SALUJA, DHANBIR MD 8/8/1941 1023045010 230 JEFFERSON STREET NEWARK NJ 07105 DEBARMENT 8/24/2013 SALUJA, DHANBIR MD 8/8/1941 1023045010 230 JEFFERSON STREET NEWARK NJ 07105 DISQUALIFICATION 6/3/2016 SALVATORE JR., THOMAS 201 HAMILTON AVENUE TRENTON NJ 08609 DISQUALIFICATION

SAMAN, AIAD L. 47 CENTER PLACE STATEN ISLAND NY 10306 DISQUALIFICATION 3/25/2009 SAMI, ASHRAF 64 CARUTH AVENUE, APT. 66 ELMWOOD PARK NJ 07407 DISQUALIFICATION 5/24/2017

SAMILLAN, HANS CHHA 8/22/1984 3-3 SYDNEY WAY LONG BRANCH NJ 07740 DISQUALIFICATION 2/8/2017 SAMUEL, DELORIS PO BOX 4004 CLINTON NJ 08809 DISQUALIFICATION 5/2/2008 SANCHEZ, MAURICE 243 PROSPECT AVENUE NORTH ARLINGTON NJ 07031 DISQUALIFICATION 1/1/2011 4/30/2012 SANCHEZ, MELISSA CHHA 1/7/1983 45 FRANKLIN PLACE TOTOWA NJ 07512 DISQUALIFICATION 7/10/2018 SANDERLIN, KATHLEEN RN 4/16/1960 824 SANIKAN TRAIL SOUTHAMPTON NJ 08088 SUSPENSION 10/18/2001 SANDERS, DENISE PHARM 3/21/1953 4 DREXEL COURT LINDENWOLD NJ 08021 DISQUALIFICATION 7/12/1995 TECH SANDERS, MICHAEL THERAPI 8/29/1964 4 CHERRY ROAD NEWTON NJ 07860 SUSPENSION 10/19/2006 ST SANDERSON, LYNN LPN/RN 7/8/1956 120 GATES MILL COURT TRENTON NJ 08690 SUSPENSION 6/20/2005 SANDFORD'S PHARMACY 128 MAIN STREET MATAWAN NJ 07747 DISQUALIFICATION 1/5/1999

SANDIEGO, NARDO MD 10/26/1935 1578508115 4 HEATHER HILL LANE SUFFERN NY 10901 DEBARMENT 10/8/2013 SANGALANG, ALEX RN 9/18/1955 21 LISA DRIVE HAZLET NJ 07730 DISQUALIFICATION 6/5/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SANGHERA, ANIL MD 1/14/1950 105 PHEASANT FIELD LANE MOORESTOWN NJ 08057 DISQUALIFICATION 5/20/2009 SANICO, ELAINE D. DPM 122 BRIGHT STREET, #1W JERSEY CITY NJ 07302 SUSPENSION 11/19/1997 SANTA MARIA, DONNA L. RN 7/3/1954 618 CINDER ROAD EDISON NJ 08820 DISQUALIFICATION 7/18/2001 SANTANA, SONIA CHHA 5/27/1939 569 E. 33RD STREET PATERSON NJ 07613 DISQUALIFICATION 3/28/2001 SANTANGELO, FRANK MD 10/4/1969 1881785293 705 HAMBURG TURNPIKE WAYNE NJ 07470 DISQUALIFICATION 11/22/2016 SANTANGELO, FRANK MD 10/4/1969 1881785293 705 HAMBURG TURNPIKE WAYNE NJ 07470 DISQUALIFICATION 3/13/2017 SANTANIELLO, RICHARD J. 3/3/1970 5 BUGLE COURT HOWELL NJ 07731 SUSPENSION 3/20/2002 SANTIAGO JR., EDDIE MD 9/2/1969 1497796973 300 SECOND AVENUE LONG BRANCH NJ 07740 DISQUALIFICATION 11/1/2014 8/22/2019 SANTIAGO, HEDBERTO CNA 9/29/1983 3265 S. US HIGHWAY 1, LOT FORT PIERCE NJ 34982 DISQUALIFICATION 9/12/2020 SANTIAGO, RANALDO GIBBSBORO ROAD LINDENWOLD NJ 08021 DISQUALIFICATION 8/10/2007 SANTIAGO, REYNALDO MD 3/8/1945 1502A MARCY PLACE PHILADELPHIA PA 19115 DISQUALIFICATION 6/16/1997 SANTIAGO, RUTH M. CHHA 2/1/1967 289 BROADWAY, APT. E NEWARK NJ 07104 SUSPENSION 7/19/2001 SANTIAGO, VANESSA 35 AMHERST ROAD SOUTH TOMS RIVER NJ 08757 DEBARMENT 5/31/2006 SANTIAGO-JIMINEZ, 4/12/1955 396 WOODLAND AVENUE SOUTH AMBOY NJ 08879 DISQUALIFICATION 9/19/2011 HERIBERTO SANTOS - ARIAS, SIMON MD 10/28/1941 1497721062 10305 NW 7TH COURT PLANTATION FL 33324 DEBARMENT 8/18/2016 SANTOS, YESTEL CHHA 7/19/1992 9 WESLEY COURT MOUNT HOLLY NJ 08060 DISQUALIFICATION 7/10/2018 SAPERSTEIN, ALAN 1538270525 30 HIGHLAND ROAD DIX HILLS NY 11746 DISQUALIFICATION 3/1/1987 SARKODIE, ALEX MD 7/27/1960 1598870271 516 YORKTOWN ROAD UNION NJ 07083 DISQUALIFICATION 9/14/2016 SARKODIE, ALEX MD 7/27/1960 1598870271 516 YORKTOWN ROAD UNION NJ 07083 DISQUALIFICATION 6/5/2017 SARVAIYA, RAMESH MD 8/6/1954 1578558748 26 EASTWOOD DRIVE VOORHEES NJ 08043 DISQUALIFICATION 5/14/2021 SATCHER, WILLIAM 558 ANDERSON AVENUE CLIFFSIDE PARK NJ 07010 DISQUALIFICATION SAUCHELLI, FRANCIS MD 10/31/1954 1124586326/ 151 BLOOMFIELD AVENUE, VERONA NJ 07044 DEBARMENT 9/13/2019 1558307934 APT. 502 SAUL, STEPHEN L. DPM 4/2/1971 76 W. JIMMIE LEEDS ROAD ABSECON NJ 08201 DISQUALIFICATION 7/18/2001 PERMANENT SAUL, STEPHEN L. DPM 4/2/1971 9 SEASIDE COURT MARGATE CITY NJ 08402 DISQUALIFICATION 9/12/2016 PERMANENT SAVINO, THOMAS MD 2/5/1959 1821087305 65 BUTTONWOOD ROAD STATEN ISLAND NY 10304 DISQUALIFICATION 8/10/2018 SAVINO, THOMAS MD 2/5/1959 1821087305 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 5/18/2019 SAYED, SAQUIB MD 9/14/1965 1609054360 4 TURTLE HOLLOW COURT SICKLERVILLE NJ 08081 DEBARMENT 4/29/2016 SAYED-BAKHATY, ABDEL MD 5/4/1954 403 HARMON TOWERS SECAUCUS NJ 07094 SUSPENSION 4/26/1995 SAYEGH, RICKY MD 4/1/1975 1346274966 4 FOWLER AVENUE YONKERS NY 10701 DISQUALIFICATION 9/19/2016 SAYEGH, RICKY MD 4/1/1975 1346274966 390 FORT HILL ROAD SCARSDALE NY 10583 DEBARMENT 11/20/2017 SBARRA, SAMUEL DC 9/3/1958 1205913100 PARK AVENUE NUTLEY NJ 07110 SUSPENSION 10/20/2008 1/20/2015 SCARPITTA, JANET 9/2/1964 92 PEABODY PLACE NEWARK NJ 07104 DISQUALIFICATION 6/15/2001

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SCERBO, ERNEST J. MD 10/9/1909 26-10 BROADWAY SUITE 103 FAIR LAWN NJ 07410 DISQUALIFICATION 6/1/1993 DECEASED

SCHECHTER, MARVIN OD 1063420453 100 YORKTOWN DRIVE MOUNT LAUREL NJ 08054 DISQUALIFICATION 6/1/1993 SCHEIN, HERBERT W. MD 2/22/1917 1027 HOOPER AVENUE TOMS RIVER NJ 08753 DISQUALIFICATION 5/30/1991 DECEASED SCHEINER, DAVE E. DPM 12/14/1950 910 BONAPARTE COURT PHILADELPHIA PA 19107 SUSPENSION 7/22/1999 SCHENKEL, CATHERINE RN 10/6/1956 87 IRVING AVENUE, APT. 3 LIVINGSTON NJ 07039 DISQUALIFICATION 6/20/2009 MICHELLE SCHENKEL, CATHERINE RN 10/6/1956 87 IRVING AVENUE, APT. 3 LIVINGSTON NJ 07039 SUSPENSION 5/30/2010 MICHELLE SCHERING SALES 2000 GALLOPING HILLS ROAD KENILWORTH NJ 07033 SUSPENSION 10/20/2005 CORPORATION SCHLACHTER, ANDREA 1/19/1971 42 WEST HOLLY STREET CRANFORD NJ 07016 SUSPENSION 11/20/2006 SCHLEMBACH, ANDREA APN/RN 7/26/1979 1780630418 70 COHANSEY STREET BRIDGETON NJ 08302 DISQUALIFICATION 9/12/2016 5/21/2020 AKA OLIVER, ANDREA SCHLISSERMAN, HERMAN 300 48TH STREET UNION CITY NJ 07087 DISQUALIFICATION

SCHMIDT, NORINE RN 7/15/1959 78 S. ROOSEVELT SQUARE ENGLEWOOD NJ 07631 DISQUALIFICATION 7/12/2018 SCHMOLK, DERRICK RN 9/22/1989 11 BEVIS LANE CAPE MAY NJ 08210 DISQUALIFICATION 2/25/2019 COURTHOUSE SCHMUCKER-KARPOW, RPH 4/6/1954 50 MAPLE AVENUE MORRISTOWN NJ 07960 DISQUALIFICATION 12/27/1995 DECEASED CELESTE SCHNEIDER, BRUCE J. DDS 11/1/1951 520 CLIFFORD AVENUE, E8 MATAWAN NJ 07747 SUSPENSION 7/20/2006 SCHNORBUS PHARMACY 351 NORTH WARREN STREET TRENTON NJ 08618 DISQUALIFICATION 8/19/1981

SCHOBERT III, WILLIAM B. 25 WELLINGTON DRIVE, #D LUMBERTON NJ 08048 DISQUALIFICATION 6/20/2009 7/14/2014

SCHRAGER, KENNETH, J. MD FCI OTISVILLE, PO BOX 600 OTISVILLE NY 10963 SUSPENSION 6/19/2001 SCHROEDER, PETER RN 6/17/1968 18 PILGRIM WAY HAMILTON NJ 08620 DISQUALIFICATION 10/11/2017 SCHULTZ, STEVEN MD 9/16/1946 1495 EAST 92ND STREET, #2 BROOKLYN NY 11236 DISQUALIFICATION 6/9/1999

SCHUTT, CHARLES 21 PARMLEY ROAD TINTON FALLS NJ 07724 DISQUALIFICATION 3/8/1978 HARDEN SCHWARTZ, EDWARD RPH 3/5/1936 60 SIP AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 8/6/1998

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SCHWARTZ, EDWARD RPH 3/5/1936 720 HARMON COVE TOWERS SECAUCUS NJ 07094 DISQUALIFICATION 1/17/2001

SCHWARTZ, EDWARD RPH 3/5/1936 1021 HERALD STREET REDLANDS CA 92374 SUSPENSION 12/20/2000 SCHWARTZ, GEORGE MD 1/2/1942 PO BOX 1806 SANTA FE NM 87504 SUSPENSION 12/19/2007 ROBERT SCHWARTZ, JADE LPN 11/16/1983 97 SHORELAND CIRCLE SOUTH AMBOY NJ 08879 DISQUALIFICATION 8/21/2018 SCHWARTZ, MARK MD 8/1/1966 1164436325 308 CHELSEA MANOR PARK RIDGE NJ 07656 DEBARMENT 11/16/2018 SCHWARTZ, MURRAY DO 9/5/1943 1063573012 5 AUTUMN COURT CHERRY HILL NJ 08003 DEBARMENT 1/23/2013 SCHWARTZ, MURRAY DO 9/5/1943 1063573012 5 AUTUMN COURT CHERRY HILL NJ 08003 DISQUALIFICATION 12/5/2013 SCHWARZ, DENISE DPM 1729 PAMMEL PARK ROAD WINTERSET IA 50273 SUSPENSION 2/20/2002 SCOPELLITI, ALDO R. DC 9/5/1958 1568524049 107 MONMOUTH ROAD WEST LONG BRANCH NJ 07764 SUSPENSION 5/12/2000

SCOTT, DEBRA 1/3/1964 2751 S. OCEAN DRIVE HOLLYWOOD FL 33019 SUSPENSION 5/20/2004 SCOTT, GLENN RN 10/8/1961 70 POLIFLY ROAD, APT. 105 HACKENSACK NJ 07601 SUSPENSION 10/18/2001 SCOTT, MARVELL MD 2/28/1973 1144417478 41 FIDDLERS WAY SPARTA NJ 07871 DEBARMENT 8/12/2020 SCOTT, MCKENZIE LPN 5/22/1986 457 REDBANK ROAD TEMPLETON PA 16259 DISQUALIFICATION 11/20/2015 SCOTT, MELVIN 11/9/1974 42 HIGHLAND TERRACE IRVINGTON NJ 07111 SUSPENSION 6/3/2001 SCULLION, FRANCES RN 20 BREAKNECK ROAD OAKLAND NJ 07436 DISQUALIFICATION 7/13/1988 SCURRY, MARSHAYA PHARM 1/15/1983 1500 GARDEN DRIVE OCEAN NJ 07712 DEBARMENT 1/4/2017 6/26/2018 SEAMAN, VIVIAN RN 4/6/1960 823 TENTH STREET UNION BEACH NJ 07735 DISQUALIFICATION 9/12/2016 SEDEHI, AHMAD DMD 6/15/1949 1063634640 31 JANE DRIVE ENGLEWOOD CLIFFS NJ 07632 DEBARMENT 7/1/2017 SEGLIN, MARK PSYCH 7/11/1944 1184754632 89 LAPIS CIRCLE WEST ORANGE NJ 07052 DISQUALIFICATION 1/1/2017 SEHGAL, GAUTAM MD 12/20/1949 1497801740 8 WINDERMERE COURT LIVINGSTON NJ 07039 SUSPENSION 5/2/2016 SEHGAL, SHASHIBALA MD 12/27/1949 630 FORT WASHINGTON NEW YORK NY 10040 SUSPENSION 12/31/2000 10/17/2018 AVENUE SELIM, HANAN RPH 9/7/1968 47 NORWOOD AVENUE CLIFTON NJ 07011 SUSPENSION 5/30/2000 SEMPLE, IVRY 724 GROVE STREET IRVINGTON NJ 07111 DISQUALIFICATION 12/24/1985 SEMPLE, IVRY 472 LAKESIDE AVENUE ORANGE NJ 07050 DISQUALIFICATION 8/14/1986 SENAPE, SAVERIO MD 1/1/1940 215 WEST 92ND STREET, 15A NEW YORK NY 10025 DISQUALIFICATION 8/5/1998

SENATORE, SALVATORE DC 2/19/1949 1073653366 342 LINCOLN DRIVE KENILWORTH NJ 07033 DISQUALIFICATION 8/19/2010 SENDER, PAUL MD 3/7/1955 1124321286 30A WEST MAPLE AVENUE MONSEY NY 10952 SUSPENSION 11/20/2006 12/22/2014 SENQUIZ, LUZ COUNSE 9/26/1951 471 HIGHLAND AVENUE, COLLINGSWOOD NJ 08108 SUSPENSION 4/29/2003 LOR APT. A

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SENTILLES, JEAN J. MD 11/27/1945 150 W 56TH STREET N 509 NEW YORK NY 10019 DISQUALIFICATION 2/27/1992 SEPAHBODY, CYRUS DDS 3/23/1967 1487706305 507 SUMMERFIELD AVENUE, ASBURY PARK NJ 07712 DISQUALIFICATION 5/18/2019 APT 2 SERENO, PATRICIA LPN/RN 7/27/1950 18 SECRETARIAT STREET HOWELL NJ 07731 SUSPENSION 9/20/2001 SERPE, JOSEPH RN 9/20/1988 459 MAIN STREET STATEN ISLAND NY 10307 DISQUALIFICATION 6/5/2017 SERRANO, KRISTINA CHHA 9/26/1995 59 ARCADIA PLACE, #B VINELAND NJ 08360 DISQUALIFICATION 2/8/2017 SESAY, CHERYL LPN 11/2/1959 12 AVA AVENUE SOMERDALE NJ 08083 SUSPENSION 10/20/2002 SESSOMS, VALERIE 12/16/1958 29 STRATFORD PLACE, APT. NEWARK NJ 07108 DISQUALIFICATION 9/20/2012 6J SEUFERT, ANNA MARIE CHHA 5/8/1990 5139 LAKE WORTH ROAD GREEN ACRES FL 33463 DISQUALIFICATION 6/19/2014 SEXTON, JILL RN 1/8/1978 5460 ROUTE 100 PLYMOUTH VT 05056 DISQUALIFICATION 9/12/2016 SHACK, DANIEL RPH 2/4/1958 2 GRACEHILL COURT TITUSVILLE NJ 08560 SUSPENSION 9/20/2006 SHAH, JAYEN C. MD 5/15/1952 MEADOWLANDS PARKWAY SECAUCUS NJ 07096 DISQUALIFICATION 7/26/1996 SHAHINE, AYMAN MD 8/15/1963 1235341850 334 86TH STREET BROOKLYN NY 10024 DISQUALIFICATION 4/1/2019 SHAKARJIAN, CARNIG C. DPM 5/9/1962 1720007743 99 KINDERKAMACK ROAD EMERSON NJ 07630 DEBARMENT 6/25/2013 SHARIF, MUDASSAR MD 3/27/1970 1366509903 308 MOUNTAIN ROAD BASKING RIDGE NJ 07920 DEBARMENT 12/16/2015 SHARIM, IRADJ MD 7/20/1942 1790739423/ 1208 BIRCH AVENUE YARDLEY PA 19067 DISQUALIFICATION 8/14/2020 PERMANENT 1588610851 SHARMA, RAVINDER MD 2/18/1953 1306947999 3 MARTIN COURT MARTINSVILLE NJ 08836 DEBARMENT 1/22/2016 1/3/2019 SHARMA, YOGENDRA P. OD 8/1/1944 17 VAHLSING WAY ROBBINSVILLE NJ 08691 DEBARMENT 2/28/2000 SHAROW, RALPH DMD 11/19/1945 1679670038 PO BOX 1000- CAMP FORT DIX NJ 08640 SUSPENSION 7/20/2003 SHAW, RICKY AKA ROSS, 12/10/1972 123 N. 19TH STREET EAST ORANGE NJ 07017 DISQUALIFICATION 10/14/2005 DOUGLAS SHEA, ANN M. RN 12/28/1973 706-08 ZLOTKIN CIRCLE FREEHOLD NJ 07728 SUSPENSION 10/18/2001 SHEIKH, IMTIAZ A. MD 2/20/1945 1008 BRAINARD PLACE BRIELLE NJ 08730 DISQUALIFICATION 12/1/1998 SHEIKH, MOHAMMAD 7/9/1953 59-07 71ST AVENUE RIDGEWOOD NY 11385 DEBARMENT 10/20/2003 SHEIKH, NAFEESA 3/11/1957 516 BLOOMFIELD AVENUE NUTLEY NJ 07110 SUSPENSION 11/20/2003 SHERANI, TAHIR S. 5/7/1965 215 N. WYOMING STREET SOUTH ORANGE NJ 07079 DISQUALIFICATION 2/7/2000 SHERMAN, HENRY M. MD 4/20/1942 1922334457 141 S. HARRISON STREET EAST ORANGE NJ 07018 DISQUALIFICATION 2/5/1997 12/14/2011 SHIELDS, HEATHER LPN 5/2/1973 100 ROLLING ACRES SLIPPERY ROCK PA 16057 DISQUALIFICATION 11/20/2015 SHIPMAN, BRYAN LEE 2/9/1973 1210 CHERSONESE ROUND MOUNT PLEASANT SC 29464 DISQUALIFICATION 3/20/2012 SHKLOVER, TOBIAS MD 5/14/1955 2611 W. 2ND STREET BROOKLYN NY 11223 SUSPENSION 9/20/2007 SHMIDMAN-HOROWITZ, 5/8/1930 8215 ABINGDON ROAD KEW GARDENS NY 11478 DISQUALIFICATION MIRIAM

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SHRAMOWIAT, MICHAEL MD 10/28/1952 1568485233 1158 46TH STREET, APT A VIENNA WV 26105 DISQUALIFICATION 5/14/2021

SHROPE, CATHY L. 5/30/1967 175 COUNTY ROUTE 519 S. BELVIDERE NJ 07823 DISQUALIFICATION 7/22/2002 SHROUT, WILLIAM 3/22/1960 PO BOX 280 FAIRTON NJ 08320 SUSPENSION 9/20/2001 SHTINDLER, EDUARD 7/14/1983 150 CUMBERLAND COURT PARAMUS NJ 07093 SUSPENSION 9/30/2019 SHULMAN, JONATHAN RN 12/18/1976 11945 NE 19TH DRIVE, APT. 1 NORTH MIAMI FL 33181 DISQUALIFICATION 5/18/2019

SHUSTER, LARRY B. RPH 1/2/1953 3136 GUILFORD STREET PHILADELPHIA PA 19152 SUSPENSION 3/9/2008 6/26/2017 SIAM, NABIL A. MD 67 HIGHWAY 37, PO BOX 193 TOMS RIVER NJ 08754 DEBARMENT 12/1/1999

SIBERT, SCOTT L. MD 43 WOODLAND AVENUE WOODBURY NJ 08096 DISQUALIFICATION 11/15/1985 DECEASED SIDDIQUI, AFTAB A. MD 12/25/1932 1073527545 504 LIVINGSTON STREET NORWOOD NJ 07648 SUSPENSION 6/19/1998 SIDDIQUI, NURUL HASAN 4/19/1948 4912 BERGENLINE AVENUE WEST NEW YORK NJ 07093 DISQUALIFICATION 1/12/1996

SIDDIQUI, SHAKIR H. 5/14/1947 619 SCHUYLER AVENUE KEARNY NJ 07032 SUSPENSION 3/10/1998 SIDDIQUI, SHOAIB H. 6/25/1953 9 TOWER DRIVE EAST HANOVER NJ 07936 SUSPENSION 7/19/2001 SIEGEL, JONATHAN B. DPM 11/30/1959 4772 HIGHWAY 9 SOUTH HOWELL NJ 07731 DISQUALIFICATION 9/11/2000 SIGLE, EDWARD 10/2/1925 CRANBURY SOUTH RIVER MONROE TOWNSHIP NJ 08831 DISQUALIFICATION 5/29/2007 ROAD SILMAN, ALEX DDS 4/7/1975 1629319751 3 CLARK PLACE MARLBORO NJ 07746 SUSPENSION 10/22/2010 1/5/2018 SILVA, SANDY COUNSE 2208 HILLCREST AVENUE PENNSAUKEN NJ 08110 SUSPENSION 4/29/2003 LOR SILVERHARDT, STEPHEN DDS 1881821403 1436 MARSHALL LANE MEADOWBROOK PA 19046 DISQUALIFICATION 2/16/1988 SILVERMAN, HAROLD 529 BROAD STREET NEWARK NJ 07102 DISQUALIFICATION SIMMONS, SHAMEKIA RIDGE AVENUE ASBURY PARK NJ 07712 SUSPENSION 8/21/2008 SIMONE, RENEE CRIVELLO RPH 7/1/1977 403 SCOTT COURT UNION NJ 07083 SUSPENSION 10/22/2010 SIMONETH, A'DAYJA CHHA 6/14/1995 711 CEDAR STREET LAKEHURST NJ 08753 DISQUALIFICATION 4/18/2017 SINGER-ANDREINI 5532 BERGENLINE AVENUE WEST NEW YORK NJ 07093 SUSPENSION 7/23/1998 PHARMACY SINGH, MANJIT MD 4/19/1943 21 LEHMAN STREET MAHWAH NJ 07430 SUSPENSION 2/24/1998 SINGH, MANJIT MD 4/19/1943 12 HARRISON MOUNT LAKE RINGWOOD NJ 07456 SUSPENSION 11/24/2007 ROAD SINGH, PRITPAUL MD 3/5/1948 1164717807 9 KINBERLY COURT VOORHEES NJ 08043 DISQUALIFICATION 4/27/2021 PERMANENT

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SINGH, SAGGOO MD 3/19/1947 485 S. DOBSON ROAD, STE. CHANDLER AZ 85224 SUSPENSION 11/20/1995 202 SINGH, SURINDER MD 4/2/1951 288 SUMMIT AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 7/23/2007 SINGLETON, RUSSELL DMD 5/28/1962 1912166133 401 BROADWAY CAMDEN NJ 08103 DISQUALIFICATION 8/9/2014 1/10/2018 SINGLETON, WANDRA LPN 6/12/1970 86 MELROSE AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 6/5/2017 SINHA, BINOD P. MD 7/26/1951 1932201662 3 HELENE AVENUE EDISON NJ 08820 DISQUALIFICATION 3/3/2017 PERMANENT SINHA, BINOD P. MD 7/26/1951 1932201662 3 HELENE AVENUE EDISON NJ 08820 DISQUALIFICATION 12/6/2017 PERMANENT SINVANY-NUBEL, AVIVA RN/APN 683 DONALD DRIVE NORTH BRIDGEWATER NJ 08807 SUSPENSION 10/20/2005

SIRIPURAPU, PADMA MD 5/12/1967 1710061056 201 LYONS AVENUE NEWARK NJ 07112 SUSPENSION 2/15/2012 12/3/2020 SIRIPURAPU, PADMA MD 5/12/1967 1710061056 1 SCENIC HILLS COURT BELLE MEAD NJ 08502 DISQUALIFICATION 12/30/2014 12/3/2020 SIROTA, ALEKSANDR 6/1/1970 PO BOX 2000 LEWISBURG PA 17837 DISQUALIFICATION 8/19/2010 SISON, JOSEPH MD 6/19/1957 1730110149 41 BROWNSTON WAY STE ENGLEWOOD NJ 07631 SUSPENSION 8/2/2011 218 SIVAKANTHA, PSYCH 11/14/1964 1114080165 PO BOX 5503 SOMERSET NJ 08875 DISQUALIFICATION 9/20/2011 SIVAGNANALIN SKAGGS, MATTHEW A. 5/31/1972 2127 QUAETHEM DRIVE CHESTERFIELD MO 63005 DISQUALIFICATION 1/20/2012 SKURATON, JEFFREY RPH 9/26/1943 WINGED FOOT DRIVE LIVINGSTON NJ 07039 SUSPENSION 6/19/2008 SLAKIE, CHRISTINE RN 6/27/1961 103 EDGE LANE WILLINGBORO NJ 08046 SUSPENSION 9/19/2003 SLATER, BARBARA A. LPN 7/28/1956 7 POINT ROAD TOMS RIVER NJ 08753 SUSPENSION 10/18/2001 SLOAN, BARRY MD 6/21/1958 1770578262 1561 LEMOINE AVENUE FORT LEE NJ 07024 DISQUALIFICATION 7/31/2018 SLOAN, DEBRA 8/16/1954 31 SCHAAF ROAD BLOOMSBURY NJ 08804 DEBARMENT 8/12/2012 SLOTNICK, SINO 1556 RIVER ROAD TEANECK NJ 07666 DISQUALIFICATION 6/1/1993 SLOVER, SHAYLA 12/15/1958 NORTH MAPLE AVENUE MARLTON NJ 08053 SUSPENSION 6/4/2007 SMITH III, RUSSELL P. LPN 7/23/1955 33 ORCHARD AVENUE PENNINGTON NJ 08534 SUSPENSION 4/19/2007 SMITH III, RUSSELL P. LPN 7/23/1955 714 S. PENNSYLVANIA MORRISVILLE PA 19067 DISQUALIFICATION 6/22/2007 AVENUE SMITH, ALPHONSO MD 2/17/1938 421 WESTWOOD DRIVE #U WOODBURY NJ 08096 SUSPENSION 7/31/2002 SMITH, CHARLES M. 11/5/1988 1825 67TH AVENUE PHILADELPHIA PA 19126 DISQUALIFICATION 11/20/2015 SMITH, DWAYNE 1/1/1965 12-14 ELM STREET, APT. 6 MONTCLAIR NJ 07042 DISQUALIFICATION 9/23/2007 SMITH, JENNIFER LYNN 11/19/1979 428 GLENWOOD AVENUE WILLIAMSPORT PA 17701 DISQUALIFICATION 11/20/2015 SMITH, JOHANNA LPN 3/26/1982 1507 ATLANTIC AVENUE, MANASQUAN NJ 08736 DEBARMENT 11/27/2018 APT. 65 SMITH, KHALILAH LPN 3/11/1977 32 ELIZABETH STREET HACKENSACK NJ 07601 DISQUALIFICATION 11/27/2018

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SMITH, LAKESIA CHHA 5/4/1983 2030 RIVERSIDE DRIVE, APT. TRENTON NJ 08618 DISQUALIFICATION 2/20/2017 10B SMITH, LARRY 9/9/1960 183 SOUTH HIGHLAND YORK PA 17404 DISQUALIFICATION 11/20/2015 AVENUE, APT. 1 SMITH, LAURA LPN 10/5/1959 1051 OLD FREEHOLD ROAD TOMS RIVER NJ 08753 SUSPENSION 10/18/2007

SMITH, MARK RPH 3/21/1977 1510 OCEAN PARKWAY #18F BROOKLYN NY 11230 DEBARMENT 1/27/2017

SMITH, TAMMY CHHA 7/16/1980 203 LAKEVIEW BOULEVARD BROWNS MILLS NJ 08015 DISQUALIFICATION 2/8/2017

SMITH, WILLIAM 6/3/1931 RT 1 35 WHITE TAIL ROAD SAN MARCOS TX 78666 DISQUALIFICATION SMITH-DORSEY, JULIA RN 12/2/1969 37 WINFIELD DRIVE PARSIPPANY NJ 07054 DEBARMENT 8/2/2017 8/22/2019 SMOLEV, JOSEPH M. MD 11/25/1909 158 HAMILTON AVENUE PASSAIC NJ 07055 DISQUALIFICATION 6/1/1993 DECEASED SMOLIN, STEVE RPH 6/14/1949 1124184619 228 KINGS HIGHWAY BROOKLYN NY 11223 DISQUALIFICATION 9/7/2001 SMUTEK, MICHELLE M. LPN 12/29/1968 2115 FLORENCE AVENUE HAZLET NJ 07735 DEBARMENT 10/20/2002 SNELL, PHILIP MD 6/12/1915 217 PAULISON AVENUE PASSAIC NJ 07055 DISQUALIFICATION 6/1/1993 SODANO, MICHAEL J. 9/10/1949 708 FOREPEAK AVENUE BEACHWOOD NJ 08722 DISQUALIFICATION 6/1/1993 SODANO, MICHAEL J. 9/10/1949 708 FOREPEAK AVENUE BEACHWOOD NJ 08722 SUSPENSION 1/6/1999 SOHN, YOUNG PSYCH 12/13/1932 63 CARLOUGH ROAD UPPER SADDLE RIVER NJ 07458 SUSPENSION 6/20/2000

SOKHA, BORIS 7/26/1954 FCI FORT DIX JOINT BASE MDL NJ 08640 SUSPENSION 5/20/2009 SOLARZ, LAUREN 7/1/1955 1133 THACKERY CIRCLE VOORHEES NJ 08043 SUSPENSION 7/19/1999 SOLBERG, BYRNE MD 6/19/1953 1710996871 107 PENN STREET RIVERTON NJ 08077 DISQUALIFICATION 11/21/2018 SOLBERG, BYRNE MD 6/19/1953 1710996871 103 FOXHALL LANE NARBERTH PA 19072 DISQUALIFICATION 11/20/2015 SOLIMANDO, LISA LPN 5/17/1972 41 LONG VALLEY ROAD LODI NJ 07644 DISQUALIFICATION 3/28/2017 SOLOMON, JENNIFER 10/22/1969 142 BROAD STREET NEWARK NJ 07104 DISQUALIFICATION 6/25/2002 SOLOMON, MARCUS 7/2/1966 142 BROAD STREET NEWARK NJ 07104 DISQUALIFICATION 6/25/2002 SOLOMONOV, MIKHAIL MD 1/26/1966 1225095672 9 HAMILTON DRIVE SOUTH NORTH CALDWELL NJ 07006 DISQUALIFICATION 10/17/2019 SOMERSET, WILLARD RPH 1123 BROAD STREET NEWARK NJ 07114 DISQUALIFICATION 1/1/1988 SONG, KI I. MD 4/20/1941 1720138936 62 COTTAGE STREET JERSEY CITY NJ 07306 SUSPENSION 4/7/2011 SONG, YO-JUN MD 8/10/1945 1982657540 1857 DIAMOND HEALTH CASTLE ROCK CO 80104 DISQUALIFICATION 8/28/2017 PERMANENT DRIVE SONG, YOUNG 37 DEANNA DRIVE EAST HANOVER NJ 07936 DISQUALIFICATION 7/19/2010 7/19/2015

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SONI, HARDIK MD 4/20/1975 1750498028 90 BEAUVOIR AVENUE SUMMIT NJ 07901 DISQUALIFICATION 7/22/2017 SONZA, PATRICIO A. MD 3/17/1945 1316974850 8 CONSTITUTION WAY FLEMINGTON NJ 08822 SUSPENSION 11/20/2010 SORBELLO, TANYA J. LPN 5/20/1969 460 NEW STREET EAST GLASSBORO NJ 08028 SUSPENSION 2/19/2004 SORONGON, MARCELINO MD 4/26/1941 192 SURREY COURT RAMSEY NJ 07446 SUSPENSION 5/18/2000

SOSTOWSKI, RICHARD M. MD 10/1/1947 1003038951 250-1 BROOK HOLLOW LANE BERNARDSVILLE NJ 07924 DEBARMENT 11/20/2014 5/16/2016

SOTO, GREGORIO 153 LEWIS STREET PERTH AMBOY NJ 08861 DEBARMENT 3/18/2015 SOUTHERN MEDICAL & 2230 S. CROSKEY STREET PHILADELPHIA PA 19145 DISQUALIFICATION 4/19/1992 SURGICAL SOUTHERN OCEAN 1346664893 1100 ROUTE 72 WEST, SUITE MANAHAWKIN NJ 08050 SUSPENSION 1/27/2017 4/27/2017 PEDIATRICS AND FAMILY 304 MEDICINE SOYFER, ALEXANDER 7/31/1955 655 AMBOY AVENUE WOODBRIDGE NJ 07095 DISQUALIFICATION 5/21/2002 SOYFER, ALEXANDER 7/31/1955 104 MAPLE HILL DRIVE WOODBRIDGE NJ 07095 SUSPENSION 6/20/2001 SPADARO, BREKKE AKA RN 6/10/1981 35 WOODROW AVENUE FRANKLIN LAKES NH 03235 DISQUALIFICATION 2/20/2018 BEST, BREKKE SPAIN, ANTHONY B. DMD 5/12/1961 1437316098 113 CRESCENT AVENUE PLAINFIELD NJ 07060 DEBARMENT 5/28/2002 SPANIER, CYNTHIA PSYCH 11/16/1958 530 BROOKDALE DRIVE PITTSBURGH PA 15215 DISQUALIFICATION 11/20/2015 SPANO, ANTHONY THERAPI 6/30/1949 176 EVERGREEN STREET HILLSDALE NJ 07642 SUSPENSION 11/20/2003 ST SPAVLIK, LAURIE R. 8/3/1968 200 EAST GRANT AVENUE SOMERDALE NJ 08083 SUSPENSION 4/19/2001 SPECIALTY CLINICAL 299 ACADEMY STREET JERSEY CITY NJ 07306 DISQUALIFICATION 12/1/1998 LABORATORY SPEDALIERE, CARMINE MD 10/27/1923 1601 KENNEDY BOULEVARD NORTH BERGEN NJ 07407 DISQUALIFICATION 7/19/1999

SPEKTOR, IOSIF G. MD 7/18/1941 1043340235 54 INDIAN DRIVE WOODCLIFF LAKE NJ 07675 SUSPENSION 9/20/2000 SPIGNER, AKOSUA RPH 10/25/1960 941 LINCOLN AVENUE GLEN ROCK NJ 07452 DEBARMENT 5/15/2014 3/3/2020 SPINAPOLICE, JOSEPH DO 4/7/1944 1063678670 811 WASHINGTON STREET PARLIN NJ 08859 DISQUALIFICATION 4/1/2016 PERMANENT SPINELLI, PAULA CHHA 4/7/1972 94 FAIR STREET HACKENSACK NJ 07601 DISQUALIFICATION 9/19/2017 SPIVEY, DEBRA RN 9/30/1983 644 STUYVESANT AVENUE, TRENTON NJ 08611 DISQUALIFICATION 6/28/2017 APT. 2 SPLITTER, SAMUEL R. MD 4/24/1914 1742 MARYLAND AVENUE CAPE MAY NJ 08204 DISQUALIFICATION 5/4/1998

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SPYRIDON-MARKER, 25 ELKINTON ROAD ALLOWAY NJ 08001 DISQUALIFICATION 10/20/2002 KAREN ST PETER, LISA 2/12/1964 PO BOX 2000 BRUCETON MILLS WV 26525 DEBARMENT 11/17/2008 STANCH, JAMES M. PSYCH 10/13/1952 160 S. LAKESHORE DRIVE MANAHAWKIN NJ 08050 SUSPENSION 5/3/2006 STANCH, JAMES M. PSYCH 10/13/1952 FCI PO BOX 350 BEAVER WV 25813 SUSPENSION 11/20/2008 STANKO-STRACK, MARY RN 8/31/1962 1348 MILLENNIUM COURT TOMS RIVER NJ 08753 DISQUALIFICATION 5/20/2010 ELIZABETH STANLEY, JAMES R. 4/7/1959 FCI FORT DIX, PO BOX 38 FORT DIX NJ 08640 SUSPENSION 12/20/2001 STANTON JR., FRANCIS X. MD 7/27/1954 1327 CAMINITO BATEA LA JOLLA CA 92037 DEBARMENT 10/18/2001 STARKMAN, MOISHE MD 7/16/1959 1871609149 2206 YELLOWSTONE ROAD CINNAMINSON NJ 08077 DISQUALIFICATION 10/11/2017 PERMANENT STATLINE AMBULANCE & PO BOX 2100 WEST PATERSON NJ 07424 DISQUALIFICATION 1/15/1987 MEDI-COACH STAVCO, INC. 300 MAIN STREET AVON NJ 07717 DISQUALIFICATION 1/11/2005 STAVITSKI, MICHAEL RPH 5/4/1963 419 FAWNS RUN MORGANVILLE NJ 07751 DISQUALIFICATION 7/12/2002 STEEL, BURTON B. MD 8/25/1923 1 ROUND HILL ROAD WASHINGTONVILLE NY 10992 DISQUALIFICATION 6/14/1984 DECEASED STEELE, JESSICA RN 2/10/1991 8 SWEETBRIAR LANE LEVITTOWN PA 19055 DISQUALIFICATION 5/25/2019 STEFANELLI, DANETTE DC 7/5/1967 1831245760 91 EAGLE ROCK AVENUE, ROSELAND NJ 07068 DISQUALIFICATION 10/28/2015 APT. A STEFANELLI, LEONARD RPH 8/21/1964 1285958645 11 DOGWOOD LANE EAST HANOVER NJ 07936 DISQUALIFICATION 11/14/2014 PERMANENT STEFANELLI, LEONARD RPH 8/21/1964 1285958645 11 DOGWOOD LANE EAST HANOVER NJ 07936 DISQUALIFICATION 3/29/2017 PERMANENT STEFANELLI, LEONARD RPH 8/21/1964 1285958645 MDC BROOKLYN 80 29TH BROOKLYN NY 11232 DISQUALIFICATION 7/20/2015 PERMANENT STREET STEFFEN, H. PAUL 10/16/1947 4305 APPLE LANE PAULSBORO NJ 08066 SUSPENSION 9/20/2001 STEFFENS, PAUL G. 8/16/1953 1778 CALICO LANE TOMS RIVER NJ 08753 DEBARMENT 4/23/2003 STEGMULLER, JOSEPH MD 3/28/1964 1093793911 15 POINT DRIVE SOMERS POINT NJ 08244 DISQUALIFICATION 1/7/2019 STEIG, HERMAN S. DPM 8/27/1951 827 CHARNWOOD DRIVE FRANKLIN LAKES NJ 07417 DISQUALIFICATION 10/19/1999 STEIN, MARSHA J. MD 5/3/1956 1831191022 5936 HOWE STREET PITTSBURGH PA 15232 DEBARMENT 3/27/2015 STEIN, MICHAEL P. MD 1/29/1949 1174607782 400 RT. 10 WEST RANDOLPH NJ 07869 DISQUALIFICATION 10/5/1999 STEIN, MICHAEL P. MD 1/29/1949 1174607782 FMC LEXINGTON LEXINGTON KY 40512 DEBARMENT 8/20/2012 STEINBRECHER, DEBRA RN 9/3/1964 2302 WIMBLEDON WAY BLACKWOOD NJ 08012 DISQUALIFICATION 2/26/2010 STEINMAN, ARTHUR C. DO 10/15/1946 301 MADISON AVENUE LAKEWOOD NJ 08701 DISQUALIFICATION 11/11/1991 STEPASCENKO, SVETLANA CHHA 10/23/1950 100 STONE HILL ROAD, APT. SPRINGFIELD NJ 07081 DEBARMENT 1/22/2016 D-12

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE STEPHENS, ALICIA T. PHARM 10/9/1980 5322 RIVERSIDE STATION BL SECAUCUS NJ 07094 SUSPENSION 11/20/2010 TECH STEPHENS, JEFFREY 5/21/1955 411 JAROB COURT POINT PLEASANT NJ 08742 SUSPENSION 3/20/2007 STEVENS, FELICIA LPN 5/30/1987 56 WERT AVENUE HAMILTON NJ 08610 DEBARMENT 3/15/2018 STEVENS, TRACY M. RN 8/13/1960 501 S. BERLIN AVENUE EGG HARBOR CITY NJ 08215 SUSPENSION 4/20/2003 STEWART, SHANTE CHHA 12/12/1971 16B WHITE HORSE PIKE WATERFORD WORKS NJ 08089 DISQUALIFICATION 1/22/2018 STIER, ERIC G. DO 891 OLENTANGY ROAD FRANKLIN LAKES NJ 07417 DEBARMENT 3/6/2000 STILL, DAWN AKA ATKINS, CHHA 9/17/1988 697 EVERETT STREET CAMDEN NJ 08104 DISQUALIFICATION 3/6/2018 DAWN STILLWAGON-AHLERS, COUNSE 11/15/1969 SUNSET LAKE ROAD HARDWICK NJ 07825 SUSPENSION 10/20/2008 DAWN LOR STILWELL, MELISSA CHHA 419 CATHERINE STREET SOMERVILLE NJ 08876 SUSPENSION 2/19/2004 STIMMEL-KEAY, LINDA 5 DRAYTON PLACE WAYNE NJ 07470 DEBARMENT 1/1/2014 STOCKELBERG, LCSW 11/10/1977 349 JESTER COURT OLD BRIDGE NJ 08857 DISQUALIFICATION 7/15/2009 11/7/2014 SHOSHANA AKA KAUFMAN, SHOSHANA STOKES, RONALD L. CHHA 11/14/1961 124 6TH AVENUE LONG BRANCH NJ 07740 SUSPENSION 9/19/2003 STOKLEY, TWANDA CHHA 7/26/1961 1372 SPRINGFIELD AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 4/18/2017 STONE, MARY E. RN 2/19/1954 132 CORBIN COURT LAKEWOOD NJ 08701 SUSPENSION 10/19/2006 STOUDEN, ELENA DDS 1/27/1964 1619199882 EAST 83RD STREET NEW YORK NY 10028 SUSPENSION 6/19/2008 STOVEKEN, ANDREW 2/4/1950 27-11 RAVENS CREST DRIVE PLAINSBORO NJ 08536 DEBARMENT 5/15/2005

STRASHNOV, ALEKSANDR CHHA 7/19/1964 4816 GONIAK DRIVE PARLIN NJ 08859 DISQUALIFICATION 5/18/2017

STRASSMAN, ALLAN 5/25/1929 5 ROANOKE AVENUE ROCKAWAY NJ 07866 SUSPENSION 11/16/1998 STRASSMAN, ALLAN 5/25/1929 5 ROANOKE AVENUE ROCKAWAY NJ 07886 DISQUALIFICATION 12/1/1998 STRASSMAN, CAROL 120 S. 20 TH STREET IRVINGTON NJ 07111 SUSPENSION 3/16/1995 STRASSMAN, WAYNE 11/17/1957 2 NEW COUNTRY ROAD SECAUCUS NJ 07094 DISQUALIFICATION 3/5/1998 STRINE JR., WALTER M. 173 ROSE VALLEY ROAD MEDIA PA 19063 SUSPENSION 7/11/2001 STROBECK, JOHN MD 9/12/1946 1215936299 12 PINE TREE DRIVE SADDLE RIVER NJ 07458 SUSPENSION 6/6/2016 STROGOV, EMILIA DPM 5/5/1945 1225115801 COOPER ROAD SCOTCH PLAINS NJ 07076 DISQUALIFICATION 3/24/1995 STRUM, MORTON W. 1360 ARBORDALE ROAD PHILADELPHIA PA 19151 DISQUALIFICATION SUGGS, SHANTAYA CHHA 10/8/1989 115 HALSTED STREET EAST ORANGE NJ 07018 DEBARMENT 12/26/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE SUH, JEFFREY ACCUPU 10/19/1959 1336523497 FCI FORT DIX, PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 9/23/2016 NCTURIS T SULAIMON, TANFEEK CHHA 10/12/1983 321 GARFIELD AVENUE TRENTON NJ 08629 DISQUALIFICATION 1/22/2018 SULIMENKO-HOFFMAN, LPN 9/15/1971 99 CREEK ROAD BRICK NJ 08724 DISQUALIFICATION 9/13/2018 KATHLEEN AKA HOFFMAN, KATHLEEN SULLIVAN, CYNTHIA AKA RPH 6/12/1966 PIN OAK COURT SHAMONG NJ 08088 SUSPENSION 4/20/2008 6/15/2017 CRITCHFIELD, CYNTHIA SULLIVAN, JOHN M. 6/3/1948 PO BOX 2000 LEWISBURG PA 17837 DISQUALIFICATION 7/30/1998 SULLIVAN, NOELLE CHHA 10/19/1986 H-9 HUNTER HILLS FLEMINGTON NJ 08822 DISQUALIFICATION 7/14/2017 APARTMENTS SUN, KENNETH MD 4/19/1961 1881693109 382 EPPS STREET WIND GAP PA 18091 DISQUALIFICATION 3/3/2017 SUN, KENNETH MD 4/19/1961 1881693109 15 MOUNTAIN TOP ROAD WIND GAP PA 18091 DISQUALIFICATION 2/20/2018 SUNG, KYUNG EUN DDS 9/9/1977 1215122205 428 RUSSELL AVENUE EDGEWATER NJ 07020 DEBARMENT 9/20/2012 2/19/2020 SURECK, MORRIS M. OD 4/20/1922 12 NORTH 4TH AVENUE HIGHLAND PARK NJ 08904 DISQUALIFICATION 7/5/1988 SUSSMAN, GERALD DO 9/3/1937 6 EAST FIRST AVENUE RUNNEMEDE NJ 08708 SUSPENSION 5/20/1998 SUTTON, DEJA CHHA 1/26/1992 802 MAIN STREET 1-3 TOMS RIVER NJ 08753 DISQUALIFICATION 5/2/2017 SVERDLOV, GREGORY 11/20/1957 269 SHEFFIELD STREET MOUNTAINSIDE NJ 07092 DISQUALIFICATION 8/7/1998 SWAIN, CHERIE CHHA 10/6/1968 2217 NORTH 43RD STREET PENNSAUKEN NJ 08110 DEBARMENT 3/6/2018 SWARAY, MAYANGBE CHHA 5/12/1985 314 MORRIS AVENUE NEWARK NJ 07103 DISQUALIFICATION 4/14/2014 SWEITZER, JANET 8/31/1930 950 ORCHARD AVENUE, LOT CAMP HILL PA 17011 DISQUALIFICATION 11/20/2015 28 SZARSZEWSKI, MARK A. RPH 6 MARIGOLD COURT EDISON NJ 08820 SUSPENSION 9/20/2005 SZTYBEL, ELVIRA 35 PEACHTREE ROAD OAKHURST NJ 07755 DISQUALIFICATION 7/18/2001 T & N PHARMACEUTICAL 90 WASHINGTON STREET EAST ORANGE NJ 07017 SUSPENSION 9/22/2000 CO. TABOTABO, ARMANDO MD 6/18/1940 12 WEST FRONT STREET KEYPORT NJ 07735 DEBARMENT 4/12/2001 TADROS, AMIR RPH 8/22/1977 6 ALEXANDER COURT JERSEY CITY NJ 07305 DISQUALIFICATION 6/30/2010 2/5/2018 TADROS, AMIR RPH 8/22/1977 6 ALEXANDER COURT, APT. JERSEY CITY NJ 07305 DEBARMENT 12/20/2012 2/5/2018 6N TAFT, ARNOLD 333 NORTH BROAD STREET ELIZABETH NJ 07028 SUSPENSION 7/21/1997 TANDLER, ROBERT OD 8/21/1950 1104812924 792 GREEN LANE UNION NJ 07013 DEBARMENT 4/29/2016 10/27/2017

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE TAORMINA, PHILIP MD 8/27/1976 1689810723 1 APPLETREE LANE SEWELL NJ 08080 DISQUALIFICATION 2/5/2019 TAPPER, FREDERIC S. DO 7/8/1951 39 BROOKSIDE DRIVE WARREN NJ 07059 DEBARMENT 8/21/2000 TAPPIA, YEALESEH CHHA 7/15/1994 941 IVORIE COURT BURLINGTON NJ 08016 DISQUALIFICATION 2/8/2017 TARA, HAROLD H. MD 10/17/1929 48 BROOKWOOD DRIVE WAYNE NJ 07470 DISQUALIFICATION 6/1/1993 DECEASED TARANTO, SHERRY L. DENTAL 26 COOMES STREET NORWICH NY 13815 DEBARMENT 12/2/2012 HYGIENI ST TARASEVICH, LISA AKA LPN 4/20/1961 206 LAKEHURST AVENUE, NATIONAL PARK NJ 08063 SUSPENSION 9/19/2002 ADAIR, LISA APT. B TARKAS, SURBHI 8 CARLTON COURT EAST BRUNSWICK NJ 08816 SUSPENSION 6/23/2004 TARTE, DEWAYNE LPN 11/3/1971 4014 HAMILTON DRIVE VORHEES NJ 08043 DISQUALIFICATION 8/17/2019 TARVER, JOLYCE CHHA 5/16/1989 15 HEATHWOOD AVENUE JACKSON NJ 08527 DISQUALIFICATION 8/22/2017 TASCA, ANTHONY J. RN 11 SAWGRASS COURT BLACKWOOD NJ 08012 SUSPENSION 10/20/2003 TAUSCHEK, JENNIFER L. CHHA 3/1/1978 154 MAPLE AVENUE TUCKERTON NJ 08087 SUSPENSION 9/20/2005 TAVERA, CESAR 2/25/1964 812 LONGWOOD AVENUE CHERRY HILL NJ 08002 SUSPENSION 9/11/2017 TAVERA, MARIA 2/25/1964 812 LONGWOOD AVENUE CHERRY HILL NJ 08002 SUSPENSION 9/11/2017 10/3/2019 TAVERA, MARIA 2/25/1964 812 LONGWOOD AVENUE CHERRY HILL NJ 08002 DISQUALIFICATION 10/3/2019 TAYLOR, BARBARA AKA 12/14/1965 363 KENTWOOD BOULEVARD BRICK NJ 08724 DEBARMENT 10/24/2008 MONDELO, BARBARA TAYLOR, JANICE CHHA 3/14/1953 66 DUFFIELD DRIVE SOUTH ORANGE NJ 07079 DISQUALIFICATION 2/8/2017 TAYLOR, KANIKA CHHA 12/22/1988 17 HUNTINGTON TERRACE, NEWARK NJ 07112 DISQUALIFICATION 9/10/2019 FLOOR 2 TAYLOR, STEVEN RN 7/19/1965 25 SYLVAN LANE WILLINGBORO NJ 08046 DISQUALIFICATION 7/20/2017 TAYLOR, THOMAS MD 7/19/1943 1356454292 1402 CASTLE COURT HOUSTON TX 77006 DISQUALIFICATION 5/1/2017 TAYLOR, TIANN RN 3/22/1967 PO BOX 4004 CLINTON NJ 08809 DEBARMENT 6/20/2006 TELANG, FRANK W. MD 12/5/1955 1497798706 1030 N. KINGS HIGHWAY CHERRY HILL NJ 08034 DEBARMENT 8/28/2014 TELANG, FRANK W. MD 12/5/1955 1497798706 1030 W. KINGS HIGHWAY CHERRY HILL NJ 08034 DISQUALIFICATION 12/5/1997 TELGHEDER, MARGARET 7/24/1954 75 SPRING VALLEY ROAD MONTVALE NJ 07645 SUSPENSION 6/20/2002

TENSLEY, SHENEQUA 10/11/1973 364 EAST MOORE STREET NORRISTOWN PA 19401 DISQUALIFICATION 11/20/2015 TERCHIO, GAETANO FRED 104 E PALISADE BOULEVARD PALISADE PARK NJ 07650 DISQUALIFICATION

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE TERPENNING, CLARENCE PHD 303 CARTER ROAD PRINCETON NJ 08540 DISQUALIFICATION 11/19/1986

TERWILLIGER, KRISTINE RN 7/8/1976 1 DUANE STREET JAMESBURG NJ 08831 DISQUALIFICATION 10/25/2016 TESHNER, TERRI PHARM 4/1/1963 300 NORTH BLACK HORSE RUNNEMEDE NJ 08078 DISQUALIFICATION 12/26/2016 TECH PIKE, APT. B-1 THAMES, DOUGLAS A. MD 7/22/1964 218 WEST AVENUE PITMAN NJ 08071 SUSPENSION 3/20/2001 THEUNE, CHRISTOPHER DO 12/30/1966 1639141583 5678 BERKSHIRE VALLEY OAK RIDGE NJ 07438 DEBARMENT 10/15/2012 10/15/2015 ROAD THEUNE, CHRISTOPHER DO 12/30/1966 1639141583 32 WARNER ROAD NEWTON NJ 07860 DISQUALIFICATION 6/5/2017 THOMAS, ERIC MD 1/16/1967 1528378072 8460 EVERGREEN DRIVE HELENA MT 59602 DISQUALIFICATION 2/22/2018 PERMANENT THOMAS, GWENDOLYN LPN 5/22/1941 48 ROANOKE STREET WOODBRIDGE NJ 07095 DISQUALIFICATION 3/3/2017 THOMAS, LISA M. CHHA 8/16/1968 402 UNION AVENUE, APT. #3 IRVINGTON NJ 07111 SUSPENSION 4/20/1999

THOMAS-MCNAIR, 6/17/1939 590 BELLVUE AVENUE TRENTON NJ 08618 DISQUALIFICATION 12/21/1999 GLORIA THOMPSON, ARTHUR V. 855 THORNHILL COURT LAKEWOOD NJ 08701 SUSPENSION 1/19/2010 THOMPSON, DAPHNE CNA 2247 HIGH STREET ORANGE NJ 07050 DEBARMENT 3/29/2002 THOMPSON, DEBORAH A. LPN 1/29/1952 1006 COLLINGS AVENUE CAMDEN NJ 08102 SUSPENSION 6/19/2003 THOMPSON, KENNETH H. EMT 12/6/1967 408 SADDLE COURT FLEMINGTON NJ 08822 DISQUALIFICATION 4/28/2003 THOMPSON, LORNA MD 6/5/1957 20 OAK POINT DRIVE SO. BAYVILLE NY 11709 SUSPENSION 8/20/2000 THOMPSON, SHAKEEMA CHHA 1/26/1982 1034 ANNA STREET ELIZABETH NJ 07201 DISQUALIFICATION 2/26/2018 THOOMPALLY, SRINATH RPH 7/30/1967 1235381443 18 LAFAYETTE CIRCLE TOTOWA NJ 07512 DEBARMENT 12/5/2013 12/17/2015 THOTTEMPUDI, VENKATA 11/4/1967 13 VINCENT BEHAN EDISON NJ 08837 DISQUALIFICATION 4/12/2012 BOULEVARD THOTTEMPUDI, VENKATA 11/4/1967 13 VINCENT BEHAN EDISON NJ 08837 DISQUALIFICATION 9/9/2013 BOULEVARD THUMMEL, HOPE LPN 11/2/1971 246 WEST BROAD STREET PAULSBORO NJ 08066 DISQUALIFICATION 11/9/2019 TICE, LINDSEY LPN 3/19/1982 20 PARVINS MILL ROAD BRIDGETON NJ 08302 SUSPENSION 9/20/2005 TIDD, MILES LPN/RN 26 CORAL TREE COURT TRENTON NJ 08648 SUSPENSION 6/20/2005 1/9/2012 TIGHE, GERALD 8/15/1957 26 SOUTH ARLENE DRIVE WEST LONG BRANCH NJ 07764 DISQUALIFICATION 12/26/2018

TIMMONS, JAWANNA CHHA 10/13/1991 609 FOURTEENTH AVENUE PATERSON NJ 07504 DISQUALIFICATION 7/10/2018 1ST FL

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE TISCORNIA, KIMBERLY RN 12/9/1972 18 TORNE MOUNTAIN ROAD WEST MILFORD NJ 07480 SUSPENSION 6/20/2005

TOBACK, BARRY RPH 4/8/1952 1375 RIVER ROAD EDGEWATER NJ 07020 SUSPENSION 6/19/2003 TOFANI, NANCY 8/3/1954 114 COUNTY ROAD 513 PITTSTOWN NJ 08867 SUSPENSION 6/14/2000 TOMLIN, CANDICE PHARM 9/23/1980 1255517934 38-19 FAIRLAWN AVENUE FAIRLAWN NJ 07410 DISQUALIFICATION 9/9/2016 TOMLIN, TERESA L. DPM 8/16/1961 232 KRISTINE AVENUE MANAHAWKIN NJ 08050 SUSPENSION 3/5/2008 TOMPKINS, AMBER LPN 7/25/1990 17 LEHIGH ROAD PARLIN NJ 08859 DISQUALIFICATION 6/15/2018 TONG, DARLENE M. RPH 9/27/1971 108 LOWER LANDSDOWN ANNANDALE NJ 08801 SUSPENSION 11/12/2009 ROAD TORIBIO, ANTHONY X-RAY 11 BYRON DRIVE LOPATCONG NJ 08865 SUSPENSION 9/28/2001 TECH TORO, NORMARY CHHA 11/16/1989 1173 ATLANTIC AVENUE, CAMDEN NJ 08104 DISQUALIFICATION 2/8/2017 APT. B TORPPEY, JONI LPN 4/5/1959 28 CHURCH ROAD NEWTON NJ 07860 DISQUALIFICATION 6/5/2017 TORRES, FRANCES AKA CHHA 3/28/1973 437 STUYVESANT AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 4/27/2007 COLON-TORRES, FRANCES

TORRES, JAIME 9/13/1950 14TH STREET, U-25 BAYAMO PR 00959 SUSPENSION 6/7/2000 VILLARICA TORRES, MANUEL G. 5/18/1945 ST. 18 ATE, PRADERA TOA BAJA PR 00940 SUSPENSION 6/7/2000 TORRES, MILESTY CHHA 6/4/1982 407 NORTH 31ST STREET CAMDEN NJ 08105 DISQUALIFICATION 1/31/2017 TORRESS, KRISTINA CHHA 8/28/1991 53 STEGMAN STREET, APT. JERSEY CITY NJ 07305 DISQUALIFICATION 1/24/2018 #4 TOSCANO, SYLVIA 13 NORTHGATE WAY TOMS RIVER NJ 08753 DEBARMENT 8/12/2013 11/14/2018 TOTH, TEREZIA M. MD 9 N 2ND AVENUE HIGHLAND PARK NJ 08904 DISQUALIFICATION 3/6/2006 TOUCH OF LIFE, LLC. CHELSEA AVENUE NEWARK NJ 07106 SUSPENSION 3/9/2008 TOUSSAINT, VALENTINA 240 WEST 104TH STREET NEW YORK NY 10025 DISQUALIFICATION 2/8/2006 TOUTEBON, LEON CHHA 11/8/1965 242 HALSTED STREET, 2ND FL EAST ORANGE NJ 07018 DISQUALIFICATION 7/10/2018

TOY, SUSAN 12/20/1971 727 SUMMIT ROAD UNION NJ 07083 DISQUALIFICATION 2/9/2017 TRASTER, LAWRENCE 19 BRAEMAR DRIVE WAYNE NJ 07470 DISQUALIFICATION 9/21/1983 TRAVERSO, JOSEPH L. MD 2/21/1946 5 OLD SALEM ROAD WEST ORANGE NJ 07052 SUSPENSION 9/20/2005 TRAYNOR, PATRICK 6/22/1941 2314 WOODLAND ROAD ABINGTON PA 19001 DEBARMENT 12/5/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE TREGO-CAMPION, ANITA RPH 8/15/1960 136 S. FELLOWSHIP ROAD MAPLE SHADE NJ 08052 SUSPENSION 10/20/2005

TREMO, GREGORY RPH 11/21/1966 13276 WHIPPINGHAM NEW CARROLTON VA 23314 SUSPENSION 11/20/2006 PARKWAY TRENTACOSTA, GREG S. DC 10/9/1971 1720293079 1565 RATZER ROAD WAYNE NJ 07470 SUSPENSION 6/20/2005 TRINIDAD, TITO B. MD 9/2/1939 PO BOX 1000 #10912-068 LEWISBURG PA 17837 SUSPENSION 11/10/1996 TRIVEDI, AMRITLAL PHD 6/30/1928 20 CYPRESS ROAD BURLINGTON NJ 08016 DISQUALIFICATION 5/2/1978 TROLLINGER, ROBERT J. MD 4/9/1926 212 ROUTE 541 NORTH MEDFORD NJ 08055 DEBARMENT 10/10/2001 TSAI, DAVID MD 11/1/1965 12 NORTH 7TH AVENUE MOUNT VERNON NY 10550 DEBARMENT 6/23/2000 TSIRKINA, NATALIA 5/21/1955 13675 PHILMONT AVENUE PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015 TUCHMAN, ALAN P. DPM 10/2/1946 1851380851 WEST MAIN STREET FREEHOLD NJ 07728 SUSPENSION 4/21/2008 8/29/2011 TUCKER, APRIL CHHA 3/11/1981 193 BENNER AVENUE NEWARK NJ 07112 DISQUALIFICATION 7/14/2017 TUCKER, BURT A DDS 11/20/1937 530 BRICK BOULEVARD BRICKTOWN NJ 08723 DISQUALIFICATION 12/31/1999 DECEASED TUCKER, KAREN E. DPM 5/24/1965 1992052930 1 BERYNWOOD AVENUE MARLTON NJ 08053 SUSPENSION 7/20/2002 7/15/2016 TUCKER, SUZANNE RN 8/1/1964 127 GAYWOOD AVENUE COLONIA NJ 07067 SUSPENSION 5/20/2001 TULSANIA, NITAN 7/1/1955 40 BROOKSIDE ROAD EDISON NJ 08817 DEBARMENT 4/27/2004 TUMAS, MARY DC 9/13/1953 537 FISK AVENUE BRIELLE NJ 08730 DISQUALIFICATION 7/28/2014 TUMIWA, ARNOLD RN 4/20/1984 44 CIRCLE PLACE LAKEWOOD NJ 08701 DISQUALIFICATION 5/2/2018 TUNG, MING C. DPM 10/15/1944 1043387608 MITCHELL AVENUE EAST BRUNSWICK NJ 08816 SUSPENSION 8/24/2007 TURNER, KIM AKA HALL, 11/18/1965 5 UNAMI LANE SCOTCH PLAINS NJ 07076 DISQUALIFICATION 1/23/2009 PERMANENT KIMBERLY AKA HALL, KIM

TURTON, IAN LPN 7/6/1968 52 BAY SHORE DRIVE TOMS RIVER NJ 08753 DISQUALIFICATION 4/24/2018 TWEED, DONNA RN 10/20/1958 60 BAYSHORE ROAD CAPE MAY NJ 08204 DISQUALIFICATION 12/30/2019 PERMANENT TYER, DOUGLAS D. 175 1ST STREET, APT. 16L NEWARK NJ 07102 DISQUALIFICATION 11/22/2005 TYRELL, MARK N. RPH 1/11/1955 58 HAVERHILL AVENUE LITTLE FALLS NJ 07424 SUSPENSION 8/19/2004 TYSHKOV, MICHAEL MD 6/30/1954 1902882038 87 SHREWSBURY DRIVE LIVINGSTON NJ 07039 DISQUALIFICATION 4/8/2019 TYSHOV, MICHAEL MD 6/30/1954 1902882038 87 SHREWSBURY DIRVE LIVINGSTON NJ 07039 DISQUALIFICATION 4/1/2021 PERMANENT UHLIG, CYNTHIA 7/26/1957 204 WYOMING STREET WESTFIELD NJ 07090 SUSPENSION 9/20/2006 UHUNMWANGHO, CHHA 11/29/1996 818 SOUTH 18TH STREET NEWARK NJ 07108 DISQUALIFICATION 9/12/2017 OZIEGBE UKO, BRIDGET CHHA 4/19/1956 47 HEMPSTEAD DRIVE SOMERSET NJ 08873 DISQUALIFICATION 7/14/2017 PERMANENT UMSTEAD, LINDA CHHA 8/13/1970 143 NORTHUMBERLAND TOMS RIVER NJ 08757 DISQUALIFICATION 7/9/2018 DRIVE

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE UNION CITY DIAGNOSTIC 2201 BERGENLINE AVENUE UNION CITY NJ 07007 DEBARMENT 6/10/2001 LAB UNITED DENTAL CENTER 35 WALLINGTON AVENUE WALLINGTON NJ 07057 SUSPENSION 9/18/2003

UNITED DIAGNOSTIC LAB, 100 CRAIG ROAD, SUITE 104 MANALAPAN NJ 07726 SUSPENSION 4/18/1997 INC. UNITED PHARMACY 1347 SPRINGFIELD AVENUE IRVINGTON NJ 07111 DEBARMENT 7/30/2005 UNIVERSAL MEDICAL LAB. 43 MOONACHIE ROAD HACKENSACK NJ 07601 DISQUALIFICATION 5/10/1999

UNIVERSAL MEDICAL 845 BERGEN AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 6/14/1994 TRANSPORTATION URVINA ESTRADA, GINA CHHA 5/18/1961 169 JACKSON STREET PASSAIC NJ 07055 DISQUALIFICATION 7/31/2017 US CLINICAL 185 S. EUCLID STREET PASADENA CA 91101 DEBARMENT 4/22/1997 LABORATORY, INC. V.C. LABORATORY, INC. 9 COURTLAND AVENUE STATEN ISLAND NY 10301 DISQUALIFICATION 3/24/2003 VALDES JR., ALFREDO TNT 10/27/1974 1780644427 135 HAZEL STREET, APT. 65 CLIFTON NJ 07011 DISQUALIFICATION 1/29/2018 MEDICAL

VALENCIA, RAFAEL MD 4/28/1950 1518045525 146 LAKEVIEW DRIVE GIBBSBORO NJ 08026 DISQUALIFICATION 11/9/2017 PERMANENT VALENZUELA, ROGER CHHA 11/4/1991 517 LINCOLN STREET UNION CITY NJ 07087 DISQUALIFICATION 2/8/2017 VALLEJOS, ANA CHHA 10/29/1975 943 NORTH BROAD STREET ELIZABETH NJ 07208 SUSPENSION 5/14/2007 VALMON, CAMILLE CHHA 10/18/1990 1106 SUMMER WIND DRIVE JONESBORO GA 30236 DISQUALIFICATION 2/8/2017

VALUE-RITE PHARMACY, 350 WEST MARKET STREET NEWARK NJ 07107 SUSPENSION 4/29/1977 INC. VANDYK, TRICIA 8/24/1975 1412 ISABELLE COURT BRICK NJ 08724 DISQUALIFICATION 8/11/2012 8/10/2014 VANSCIVER, SUZANNE RN 10/4/1965 1187 NESHAMINY VALLEY BENSALEM PA 19020 DISQUALIFICATION 6/28/2017 DRIVE VARSOS, ARISTIDES G. MD 2/26/1925 28 47 37TH STREET ASTORIA NY 11103 DISQUALIFICATION 2/24/1986 DECEASED VASKO, OLGA 7/27/1968 3 PARKWOOD DRIVE SOUTH AMBOY NJ 08879 DISQUALIFICATION 7/10/2003 11/18/2019 VASOYA, PRAVIN MD 3/27/1967 1770665135 METROPOLITAN DETENTION BROOKLYN NY 11232 DISQUALIFICATION 8/1/2009 CTR. #41549-050

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE VASSERMAN, ALEKSANDR PARAME 10/7/1983 851 RED LION ROAD, APT. E1 PHILADELPHIA PA 19115 DISQUALIFICATION 11/20/2015 DIC VASSERMAN, IRINA 11/30/1962 851 RED LION ROAD, APT. E1 PHILADELPHIA PA 19115 DISQUALIFICATION 11/20/2015 VASTEY, GARDY DC 3/25/1970 1114148806 1144 USTLER ROAD APOPKA FL 32712 DISQUALIFICATION 6/28/2017 VASWANI, VIJAY MD 11/29/1968 1194785956 9 TYNMOUTH DRIVE LUMBERTON NJ 08048 DEBARMENT 2/15/2016 VECCHIONE, JOHN DDS 6/5/1968 1710926076 2 LORRAINE DRIVE PARK RIDGE NJ 07656 DEBARMENT 8/31/2016 VECCHIONE, JOHN DDS 6/5/1968 1710926076 1 CAROL DRIVE ENGLEWOOD CLIFFS NJ 07632 DISQUALIFICATION 2/20/2017 VEGA, DEBORAH 9/30/1958 2409 BOOKER AVENUE UPPER CHICHESTER PA 19014 DISQUALIFICATION 11/20/2015 VELOSO, CESAR MD 2/16/1939 1104800333 532 AMSTERDAM AVENUE RIDGEWOOD NJ 07450 DISQUALIFICATION 6/20/2018 VENANZI, ENZO DO 9/29/1927 107 NORTH BROAD STREET WOODBURY NJ 08096 DISQUALIFICATION 9/9/1996 VENDETTI CLINICAL 904D OAK TREE ROAD SOUTH PLAINFIELD NJ 07080 DEBARMENT 12/1/1999 LABORATORY, INC. VENKATRAM, MD 5/6/1955 3305 VILLAGE DRIVE AVENEL NJ 07001 DEBARMENT 11/28/1998 PRABHAKAR VENTURA, MARIA CHHA 8/2/1946 135 BELMONT STREET, #204 JERSEY CITY NJ 07304 DISQUALIFICATION 8/22/2017

VERBARO, DENNIS DC 1/9/1951 1558426122 384 MAIN STREET CHESTER NJ 07930 DISQUALIFICATION 12/1/1998 VERDELL, CLARENCE MD 7/13/1950 1649206376 107 WHITEHALL DRIVE VOORHEES NJ 08043 DISQUALIFICATION 8/20/2018 VICENTI, CARMILLA C. MD 40-15 QUAIL RIDGE ROAD PLAINSBORO NJ 08536 SUSPENSION 3/18/1999 VICIOSO, MARGARITA MD 4/9/1959 1922058932 7801 BUSTLETOWN AVENUE, PHILADELPHIA PA 19152 DISQUALIFICATION 12/29/2015 APT. 104 VICTORY PHARMACY 1238 SPRINGFIELD AVENUE IRVINGTON NJ 07111 SUSPENSION 2/2/2008 VIGGIANO, DIANE RN 5/24/1989 188 COACHMAN DRIVE N FREEHOLD NJ 07728 DISQUALIFICATION 7/22/2017 VILLAMOR, MANUEL THERAPI 11/8/1953 9030 SW 29TH TERRACE MIAMI FL 33155 SUSPENSION 3/20/2005 ST VILLONE, MARY 10/13/1956 DUNMORE STREET JIM THORPE PA 18512 DISQUALIFICATION 5/4/2005 VILSHTEYN, ROSTISLAV 9/7/1978 50 PAMELA LANE STATEN ISLAND NY 10304 DISQUALIFICATION 10/31/2012 VINCI, JUDITH RN 12/21/1948 202 BRUNSWICK AVENUE SPOTSWOOD NJ 08884 SUSPENSION 6/19/2003 VINING, DONNA DO 12/27/1950 33 1/2 PEMBROOKE ROAD DANBURY CT 06811 DEBARMENT 7/5/2001 VINUELA, ANDRES MD 3/17/1973 1649539479 1910 NE 27TH COURT, APT. 1 LIGHTHOUSE POINT FL 33064 DEBARMENT 7/15/2019

VIRZI, JOSEPH PO BOX 164 JAMESBURG NJ 08831 SUSPENSION 1/9/1996 VISCOMI, DOMINIC A. DDS 10/29/1941 926 DUCK POND ROAD NEWTON NJ 07860 DEBARMENT 5/31/2001

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE VISCONTI, PAUL A. DO 10/13/1964 120 OLD COMMACK ROAD KINGS PARK NY 11754 DEBARMENT 6/27/2001 10/25/2013 VITALE, JACK RPH 9/5/1940 17 CORNELL PLACE MANALAPAN NJ 07726 SUSPENSION 6/22/1999 VITALE, JACK RPH 9/5/1940 17 CORNELL PLACE MANALAPAN NJ 07726 SUSPENSION 5/2/2000 VITALI, JOHN MD 12/5/1961 1609829985 1 SHIRA LANE MANALAPAN NJ 07726 DEBARMENT 1/22/2016 VITALI, JOHN MD 12/5/1961 1609829985 1 SHIRA LANE MANALAPAN NJ 07726 DISQUALIFICATION 6/3/2016 VOGEL III, FRANK MD 1/6/1945 271 BELMONT PLACE MAHWAH NJ 07430 DEBARMENT 8/28/2014 VOGEL, BARRY M. MD 5/26/1942 200 HIGHLAND AVENUE GLEN RIDGE NJ 07028 DEBARMENT 9/8/2000 VOROBYEV, LEONID MD 4/10/1961 1245259431 PERRY STREET MORGANVILLE NJ 07751 SUSPENSION 8/20/2008 6/17/2014 VOUDOURIS, APOSTOLOS MD 8/16/1973 1801160767/ 3 HUNTERS CROSSING ROAD SOMERSET NJ 08873 DISQUALIFICATION 8/16/2017 12/2/2018 1902842446/ 1235437534 VOUDOURIS, APOSTOLOS MD 8/16/1973 1801160767/ 3 HUNTERS CROSSING ROAD SOMERSET NJ 08873 DEBARMENT 12/3/2018 1902842446/ 1235437534 VOUDOURIS, APOSTOLOS MD 8/16/1973 1801160767/ FMC DEVENS, PO BOX 879 AYER MA 01432 DISQUALIFICATION 5/18/2019 #71010-050 1902842446/ 1235437534 VOYTENKO, DC 10/10/1971 1174556229 2780 WEST 5TH STREET, APT. BROOKLYN NY 11224 DISQUALIFICATION 2/11/2016 CONSTANTINE 12A VOZNYUK, PETRO CHHA 1/7/1954 5 PULAWSKI AVENUE SOUTH RIVER NJ 08882 DISQUALIFICATION 2/20/2017 VOZNYUK, PETRO CHHA 1/7/1954 5 PULAWSKI AVENUE SOUTH RIVER NJ 08882 DEBARMENT 4/18/2017 WACTOR, DONNA RN 6/26/1955 71 FOREST STREET MONTCLAIR NJ 07042 SUSPENSION 6/19/2003 WAGERS, DAVID OD 8/12/1970 1710928239 540 OLD FARM ROAD PALMYRA PA 17078 DISQUALIFICATION 11/20/2015 WALDRON, JOHN F. MD 6/20/1914 920 CEDARBRIDGE ROAD BRICKTOWN NJ 08723 DISQUALIFICATION 6/21/1979 WALKER, ASHLEY RN/PA 5/1/1989 841 HILLTOP ROAD ERIE PA 16509 DISQUALIFICATION 11/20/2015 WALKER, BARBARA D. CHHA 1/22/1966 120 N. ORATON PARKWAY, EAST ORANGE NJ 07017 DISQUALIFICATION 7/20/2002 APT. 21 WALKER, RUSSELL 12/20/1983 910 MORNING GLORY ROAD JACKSON NJ 08527 DISQUALIFICATION 1/10/2010

WALL PHARMACY 2510 BELMAR BOULEVARD WALL NJ 07719 SUSPENSION 2/5/2003 WALLER, ALFONSO H. MD 3/14/1931 131 37TH STREET UNION CITY NJ 07087 DISQUALIFICATION 9/14/1983 WALLIS, JODIE RN 11/17/1964 601 FAIRVIEW LANE WILLINGBORO NJ 08046 SUSPENSION 10/18/2001 WARD, KEVIN DDS 8/13/1957 1487842647 27 FIRETOWER ROAD BUDD LAKE NJ 07828 DISQUALIFICATION 11/1/2019 PERMANENT

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE WARD, KEVIN DDS 8/13/1957 1487842647 27 FIRETOWER ROAD BUDD LAKE NJ 07828 DEBARMENT 9/15/2017 WASHINGTON JR., CHHA 7/30/1993 174 EAST 6TH STREET CLIFTON NJ 07011 DISQUALIFICATION 2/8/2017 ANKOMO WASHINGTON, JOHN 9/13/1951 2 TUERS PLACE MONTCLAIR NJ 07043 SUSPENSION 4/29/1997 WASHINGTON, CHHA 11/28/1991 144 BIDWELL AVENUE JERSEY CITY NJ 07305 DISQUALIFICATION 2/8/2017 WAH'TAYVIA WASHINGTON-BHAMRE, APN/RN 9/15/1965 166 MAPLE STREET, APT. 23 ROSELLE PARK NJ 07204 DISQUALIFICATION 3/2/2020 SHARON WASSEF, ADEL A. MD 2/10/1932 123 SOUTH MUNN AVENUE EAST ORANGE NJ 07019 SUSPENSION 2/18/1998 WATSON, LORENZO PHARM 8/7/1984 500 ADAMS LANE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 11/21/2016 TECH WATSON, MARC C. MD 2/29/1948 1578605929 912 POMPTON AVENUE, CEDAR GROVE NJ 07009 SUSPENSION 4/1/2001 #9B1 WATSON, TRACEY L. LPN 12/23/1970 1 GRUMMAN AVENUE, APT. NEWARK NJ 07112 DISQUALIFICATION 1/23/2006 4F WATZMAN, MARC MD 7/6/1966 PO BOX 1000 LORETTO PA 15940 DEBARMENT 8/30/2007 HOWARD WEAH, JEROME 2/23/1976 PO BOX 190 AVENEL NJ 07001 DISQUALIFICATION 1/14/2011 WEBB, ALNESHA CHHA 1/7/1993 328 IRVINE TURNER ROAD NEWARK NJ 07108 DISQUALIFICATION 1/29/2018 WEBB, CURTIS O. RN 12/23/1952 110 CROSSHILL DRIVE BANGOR PA 18013 SUSPENSION 12/19/2002 WEBB, LATISA CHHA 2/1/1973 1060 BROAD STREET, APT. NEWARK NJ 07102 DISQUALIFICATION 5/9/2019 504 WEBER, MARC DDS 6/2/1966 1609064062 326 BROAD STREET RED BANK NJ 07701 SUSPENSION 11/5/2009 9/30/2010 WEBER, MARGARET LPN 10/23/1958 2920 STATE ROUTE 23 NEWFOUNDLAND NJ 07435 SUSPENSION 12/18/2003 WEIDER, ABE 3301 FOSTER AVENUE BROOKLYN NY 11203 SUSPENSION 12/21/2001 WEIGAND, DAVID RN 1/13/1969 310 VILLAGE DRIVE SOMERSET NJ 08873 SUSPENSION 3/20/2001 WEIN, FRED R. RPH 10/5/1953 111 TANGERINE DRIVE MARLBORO NJ 07746 SUSPENSION 5/19/2005 WEINSTEIN, LEONARD MD 10/15/1931 1 TRENT ROAD MONROE TOWSHIP NJ 08831 SUSPENSION 8/20/2003 WEINSTEIN, MARTIN H. DPM 12/30/1955 601 2ND AVENUE LONG BRANCH NJ 07740 DISQUALIFICATION 6/19/2008 WEINTRAUB, FREDERICK DPM 10/12/1951 1225131550 17 HARVEY LANE UPPER SADDLE RIVER NJ 07458 DISQUALIFICATION 2/15/2016

WEISELBERG, ALAN 12/7/1945 8900 S.W. 61ST STREET MIAMI FL 33156 DISQUALIFICATION 6/5/2000 WEISS, CHERIE PA 4/21/1976 1861435828 801 ABBEY ROAD MIDDLETOWN NJ 07748 DEBARMENT 12/16/2015

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE WEISS, MURRAY 12/25/1925 80 SKY MEADOW WHITE PLAINS NY 10607 DISQUALIFICATION WELCH, SHIRLEY 5/8/1947 SCENIC DRIVE FREEHOLD NJ 07728 SUSPENSION 8/20/2007 WELLES, ANTONNETTE CHHA 10/21/1994 124 S. OLDEN AVENUE TRENTON NJ 08609 DISQUALIFICATION 2/8/2017 WELLS, CHRISTOPHER W. RPH 1/19/1966 WARRENS WAY WANAQUE NJ 07645 DEBARMENT 10/1/2007 WELLS, TAMARA RN 2/9/1960 13 HENRY STREET BERGENFIELD NJ 07621 DISQUALIFICATION 6/8/2018 WELLS, WARREN CHHA 11/1/1971 202 BEAR BROOK ACRES MADISON TOWNSHIP PA 15663 DISQUALIFICATION 11/20/2015 DRIVE WERBIN, MARIS AKA RPH 8/11/1957 126 RIVER DRIVE LAKE HIAWATHA NJ 07034 SUSPENSION 8/20/2006 WHITNEY, MARIS WERTHEIM, HOWARD RPH 8/18/1948 19 KNOB HILL ROAD HACKETTSTOWN NJ 07840 SUSPENSION 12/20/2004 WERTHEIM, HOWARD RPH 8/18/1948 696A FRIAR COURT MANCHESTER NJ 08759 DISQUALIFICATION 12/12/2016 WERTHEIM, MARC DDS 10/9/1964 1306910427 24 MERCHANTS WAY COLTS NECK NJ 07722 DEBARMENT 8/25/2009 WERTHEIM, MARC DDS 10/9/1964 1306910427 80 E. JOSEPH STREET MOONACHIE NJ 07074 DISQUALIFICATION 1/20/2013 WESHNAK, NADIA LPN/RN 1/23/1962 382 WOODLAKE MANOR LAKEWOOD NJ 08701 SUSPENSION 10/20/2002 DRIVE WESLEY, JOSEPH W. MD 10/9/1948 246 N FRANKLIN TURNPIKE RAMSEY NJ 07446 DISQUALIFICATION 6/19/2002 WESLEY, LACHAE'YA CHHA 7/9/1989 732 OCEAN AVENUE, APT. 11 LONG BRANCH NJ 07740 DISQUALIFICATION 4/18/2017

WESLEY, NUEDAH 7/27/1973 10 ROANOKE COURT WILLINGBORO NJ 08046 DEBARMENT 5/28/2013 WEST ORANGE 1548326812 11 DOGWOOD LANE EAST HANOVER NJ 07936 DISQUALIFICATION 3/29/2017 PERMANENT PHARMACY WESTFIELD AVENUE 156 COUNTRY FARM ROAD MARLTON NJ 08053 DISQUALIFICATION 9/26/2013 PHARMACY WESTON, MARC OD 4/18/1937 16 BARNETT ROAD LAWRENCEVILLE NJ 08648 DISQUALIFICATION 6/1/1993 WHETSTONE, RHONDA CHHA 8/9/1983 73 PEABODY PLACE NEWARK NJ 07104 DISQUALIFICATION 7/27/2017 WHITE, CAMEO CHHA 1/19/1969 493 SUMMER STREET #1 PATERSON NJ 07501 DISQUALIFICATION 7/9/2018 WHITE, MEGHAN AKA CHHA 11/23/1992 271 SERPENTINE DRIVE BAYVILLE NJ 08721 DISQUALIFICATION 5/8/2019 MCLEOD, MEGHAN WHITE, PHAEDRA J. RN 3/5/1966 1107 N SALINA STREET #2 SYRACUSE NY 13202 DEBARMENT 11/20/2008 WHITE, WAYNE RPH 4/14/1960 1366717514 11001 NORTHWEST 17TH MIAMI FL 33167 DISQUALIFICATION 11/20/2015 AVENUE WHITE, WENDELL CHHA 4/15/1969 106B CHAUCER ROAD MOUNT LAUREL NJ 08054 DEBARMENT 10/25/2003

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE WHITEHEAD, TARSHEEKA CHHA 1/4/1983 1751 OLIVER STREET RAHWAY NJ 07065 DISQUALIFICATION 2/8/2017

WHITEMAN, GERALD J. DDS 2/5/1939 1821191982 RIVERGATE WAY LONG BRANCH NJ 07740 DISQUALIFICATION 1/5/2007 8/22/2019 WHITMORE, SHARON T. 1/8/1967 51 DOVER STREET, 2ND NEWARK NJ 07106 DEBARMENT 9/19/2002 FLOOR WHITMORE, SHARON T. 1/8/1967 51 DOVER STREET, 2ND NEWARK NJ 07106 DISQUALIFICATION 8/15/2005 FLOOR WHITNEY, MARIS AKA RPH 8/11/1957 126 RIVER DRIVE LAKE HIAWATHA NJ 07034 SUSPENSION 8/20/2006 WERBIN, MARIS WHITTAKER, MICHELLE CHHA 6/4/1992 801 1/2 4TH AVENUE NEPTUNE NJ 07753 DEBARMENT 8/29/2017 WIBLE, BETH RN 11/22/1972 47 NARCUSSUS LANE LEVITTOWN PA 19054 DISQUALIFICATION 6/22/2019 WIJETILAKA, ROHAN MD 12/8/1948 1821058694 FCI FORT DIX - PO BOX 2000 FORT DIX NJ 08640 DISQUALIFICATION 5/20/2015

WIKLINSKI, STEPHEN L. DC 10/1/1964 1659454981 DEWOLF ROAD OLD TAPPAN NJ 07675 SUSPENSION 10/18/2001 WILKING, JULIE RN 8/7/1979 415B WHITMAN DRIVE HADDONFIELD NJ 08033 DISQUALIFICATION 5/2/2017 WILKINSON, CHERICE RN 12/12/1973 809 PASSAIC AVENUE SEWELL NJ 08080 DISQUALIFICATION 8/3/2019 WILKINSON, PHYLLIS LPN 7/5/1963 8 WINDING RIDGE COURT NEPTUNE NJ 07753 SUSPENSION 9/20/2006 WILLARD, VANCE CHHA 4/17/1956 283 FORD AVENUE WESTWOOD NJ 07675 DEBARMENT 1/25/2018 WILLER, MAURICE MD 3/19/1928 631 NYE AVENUE IRVINGTON NJ 07111 DEBARMENT 11/6/2000 WILLIAMS JR., OTIS A. MD 11/9/1962 106 W. PALISADE AVENUE, ENGLEWOOD NJ 07631 SUSPENSION 7/27/1998 STE 201 WILLIAMS JR., OTIS A. MD 11/9/1962 293 CLASSON AVENUE, APT. BROOKLYN NY 11205 SUSPENSION 2/2/1999 2R WILLIAMS, AMY 5/14/1967 1126 COLLINS ROAD CAMDEN NJ 08104 DEBARMENT 7/15/2004 WILLIAMS, ARNISSA 2/18/1974 256 1/2 SOUTH 19TH STREET NEWARK NJ 07103 DISQUALIFICATION 3/25/2006

WILLIAMS, BEATRICE CHHA 1/28/1947 37 VIVIAN COURT HOWELL NJ 07731 DISQUALIFICATION 4/22/2002 WILLIAMS, CONRAD D. MD 1/28/1949 1841410701 255 EASTERN PARKWAY, BROOKLYN NY 11238 DISQUALIFICATION 8/20/2015 APT. A16 WILLIAMS, CRAIG DMD 3/30/1957 175 CROSS KEYS ROAD BERLIN NJ 08009 SUSPENSION 1/18/2007 WILLIAMS, DENEESHAH CHHA 11/6/1991 133 WILLIAM STREET ROSELLE NJ 07203 DISQUALIFICATION 2/8/2017 WILLIAMS, DESHAWNA CHHA 11/26/1989 112 CORAL STREET PATERSON NJ 07522 DISQUALIFICATION 9/26/2017 WILLIAMS, DIONE MD 12/15/1958 1356437693 1787 SPRINGFIELD AVENUE MAPLEWOOD NJ 07040 DEBARMENT 12/16/2015

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE WILLIAMS, HELIEN 1/25/1986 29 STRATFORD PLACE, APT. NEWARK NJ 07104 DISQUALIFICATION 8/26/2013 2F WILLIAMS, JAMES LLOYD THERAPI 5/26/1966 208 NORTH CHESTNUT SCOTTDALE PA 15683 DISQUALIFICATION 11/20/2015 ST STREET WILLIAMS, JEWEL CHHA 6/3/1990 944 MORTON STREET CAMDEN NJ 08105 DEBARMENT 9/23/2014 WILLIAMS, JOHKEMIA CHHA 11/26/1981 7 MELLON STREET TRENTON NJ 08618 DISQUALIFICATION 2/8/2017 WILLIAMS, MARCUS MD 6/19/1958 1619057734 1500 LOCUST STREET, APT. PHILADELPHIA PA 19102 DISQUALIFICATION 11/20/2015 3912 WILLIAMS, MECCA CHHA 12/7/1992 126 PARKER STREET NEWARK NJ 07104 DISQUALIFICATION 2/8/2017 WILLIAMS, VINETTIA 3/6/1966 418 SASSAFRAS STREET MILLVILLE NJ 08360 SUSPENSION 8/20/2006 WILLIAMS-KLENA, JOAN 7/7/1933 103 KOMORN STREET NEWARK NJ 07105 DISQUALIFICATION 6/17/1987 WILLIAMSON, HELEN 11/4/1981 41 ATLANTIC AVENUE MANAHAWKIN NJ 08050 SUSPENSION 2/20/2008 WILLS, LAURA LPN 5/12/1989 14 E. WIND TRAIL, #22 FAIRFIELD PA 17320 DISQUALIFICATION 11/20/2015 WILSHIRE, GILBERT MD 5/11/1961 1386679298 1120 ROUTE 22 E BRIDGEWATER NJ 08807 DEBARMENT 12/3/1999 WILSON III, FRANKIE M. 3/10/1941 395 NORTH GROVE STREET EAST ORANGE NJ 07017 DEBARMENT 11/24/2007 WILSON, ELLEN RN/APN 2/3/1975 1144406620 42 THEO COURT BURLINGTON NJ 08016 DISQUALIFICATION 11/20/2015 10/27/2017 WILSON, EVELYN LCSW 4/30/1941 209 W. HUDSON AVENUE ENGLEWOOD NJ 07631 DISQUALIFICATION 8/15/2007 WILSON, IAN 6/6/1955 724 GROVE STREET IRVINGTON NJ 07111 DISQUALIFICATION 12/24/1985 WILSON, TAKEELA CHHA 8/31/1979 135 BERGEN AVENUE, APT. 2- JERSEY CITY NJ 07305 DISQUALIFICATION 4/7/2017 E WILSON, TASHA M. CHHA 8/25/1971 124 YORK STREET, APT. 64 SALEM NJ 08079 DISQUALIFICATION 1/6/2006 WINDMILLER, EDWARD DDS 5/30/1961 1871914036 3731 WALNUT STREET, APT. HARRISBURG PA 17109 DISQUALIFICATION 12/29/2015 A WINEGARDEN, ROBERT F. DMD 1/21/1949 1306056981 1 ROUTE 27, PARSONAGE EDISON NJ 08820 SUSPENSION 9/20/1999 ROAD WINEGRAD, ALBERT MD 9/26/1926 1972752855 3220 LENAPE DRIVE DRESHER PA 19025 DISQUALIFICATION 11/20/2015 WINGROVE DRUGS, INC. 634 DR. MARTIN L. KING NEWARK NJ 07102 SUSPENSION 6/5/1997 BOULEVARD WINKY, INC. 2510 BELMAR BOULEVARD WALL NJ 07719 DISQUALIFICATION 1/11/2005 WINTER, JESSICA CHHA 7/9/1986 426 CATHERINE STREET BERGENFIELD NJ 07621 DISQUALIFICATION 2/20/2017 WINTHER-GALIMORE, DC 2/1/1975 1134140601 1152 W. US HIGHWAY 54 CAMDENTON MO 65020 DISQUALIFICATION 9/20/2011 WISCH, GLENN R. DMD 12/1/1955 6-05 SADDLE RIVER ROAD FAIRLAWN NJ 07410 DISQUALIFICATION 4/29/1996 WITEK JR., JOSEPH T. MD 4/28/1969 1063606838 3625 AVENIDA MADEIRA BRADENTON FL 34210 DEBARMENT 10/17/2000

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE WITHINGTON, PAMELA RN 9/9/1960 5 CHERRYVILLE ROAD FLEMINGTON NJ 08822 SUSPENSION 6/20/2005 WITMAN, LEEANN 12/30/1964 SCI CAMBRIDGE SPRINGS, CAMBRIDGE SPRINGS PA 16403 DISQUALIFICATION 11/20/2015 451 FULLERTON AVENUE WOLF, JEFFREY A. DPM 9/14/1948 1100 CLIFTON AVENUE CLIFTON NJ 07103 DISQUALIFICATION 10/14/1997 WOLFE, JOSEPH ROUTE 24 MENDHAM NJ 07945 DISQUALIFICATION 6/1/1993 WOLFE, MARY LPN 10/5/1953 2760 PINE GROVE ROAD YORK PA 17403 DISQUALIFICATION 11/20/2015 WOLFE, WILLIAM MD 10/5/1963 1003872912 27 ROCKINGHAM DRIVE MARLTON NJ 08053 DISQUALIFICATION 9/12/2016 10/18/2019 WOLFF, MICHAEL W. LPN 4/15/1986 178 WHITES HILL ROAD ROCHESTER PA 15074 DISQUALIFICATION 12/29/2015 WOLFSON, STANLEY MD 11/3/1929 5 CLUBWAY LANE HARTSDALE NY 10530 SUSPENSION 4/19/2001 WOLLMAN, ROBERT DDS 5/11/1951 1659429421 461 CENTRAL AVENUE JERSEY CITY NJ 07307 DISQUALIFICATION 11/6/1987 WOOD, FAYE W. CHHA 6/30/1958 33 WHITE OAK DRIVE PRINCETON NJ 08540 DISQUALIFICATION 9/25/2002 WOODS, CALEDA CHHA 7/25/1977 158 GIRARD AVENUE TRENTON NJ 08638 DISQUALIFICATION 2/8/2017 WOODSON, BASSEY 10/4/1962 32 DAYTON STREET, APT. B1 NEWARK NJ 07114 DISQUALIFICATION 9/13/2013 JUSTICE WOROSILO, SHARON MD 12/18/1960 1000 AVENUE AT PORT WEEHAWKIN NJ 07086 DISQUALIFICATION 11/8/2017 IMPERIAL WOUND HEALING 3111 ROUTE 38 MOUNT LAUREL NJ 08054 SUSPENSION 11/19/2005 ASSOCIATES WOZUNK, GEORGE 9/23/1963 1029 E. PARK AVENUE VINELAND NJ 08360 SUSPENSION 3/10/2000 WREH-TOE, PALLEH 9/1/1964 3401 MERLOT COURT YORK PA 17404 DISQUALIFICATION 12/29/2015 WREIOLE, AUGUST DO 8/21/1949 1942247333 422 MORRIS AVENUE LONG BRANCH NJ 07740 DEBARMENT 7/8/2017 6/12/2019 WRIGHT, KIMBERLY A. RN 8/15/1965 27 GLENSIDE AVENUE SUMMIT NJ 07901 SUSPENSION 10/20/2002 WRIGHT, LYNN I. 2/23/1970 84 PENN STREET BRIDGETON NJ 08090 SUSPENSION 8/17/2008 WRIGHT, SALLY A. PSYCH 10/27/1953 1497769160 ALDERSON FPC, GLEN RAY ALDERSON WV 24910 DEBARMENT 9/19/2011 ROAD BOX A WRIGHT, SANDRA CHHA 6/22/1957 4938 NORTH 8TH STREET PHILADELPHIA PA 19120 DISQUALIFICATION 11/20/2015 WRIGHT, SHELLY L. RN 9/10/1959 MURTLAND STREET SPRINGDALE PA 15144 DISQUALIFICATION 9/23/2007 WRIGHT, SHONEYEH 9/22/1982 CLINTON AVENUE IRVINGTON NJ 07111 DEBARMENT 10/5/2007 WRIGHT, SYDNEY CHHA 8/22/1991 111 SHERWOOD AVENUE MAHWAH NJ 07430 DISQUALIFICATION 4/18/2017 WUJACK, ALLISON LPN 10/25/1983 308A SUNRISE BOULEVARD FORKED RIVER NJ 08731 DISQUALIFICATION 5/2/2017 WYLES, KIMBERLY CHHA 12/31/1989 116 BLACKWOOD- CLEMONTON NJ 08021 DEBARMENT 3/5/2018 CLEMONTON ROAD WYLIE, JOHN D. RPH 11/28/1950 7306 WOODVIEW WAY MALVERN PA 19355 SUSPENSION 7/20/2004

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE YAEGER, CHARLES 8/30/1978 21 BARKALOW AVENUE FREEHOLD NJ 07728 DISQUALIFICATION 6/5/2008 YAEGER, HOPE W. RN 9/30/1969 1316 S. 10TH STREET, APT. 2 ALLENTOWN PA 18103 SUSPENSION 8/20/2001 1/5/2018 YAHAV, ERIC MD 6/23/1975 1013156686 1720 DEVONSHIRE ROAD DRESHER PA 19025 DEBARMENT 1/1/2020 5/6/2021 YAKHNIS, ANNA RN 8/31/1975 28 SAINT MICHAELS COURT CHURCHVILLE PA 18966 DISQUALIFICATION 11/20/2015 YALE, DONNA APPEL LPN 5/2/1954 49 ANGLE INN TRAILER FARMINGDALE NJ 07727 SUSPENSION 9/20/2000 COURT YANGBE, PATIENCE CHHA 2/19/1990 730 FRANKLIN STREET TRENTON NJ 08610 DISQUALIFICATION 2/8/2017 YATES, QIANNA CHHA 5/5/1979 209 EUTAW STREET CAMDEN NJ 08105 DISQUALIFICATION 4/19/2018 YAW, GAYFORD A. PHARM 5/11/1963 504 STEVENS ROAD LANDING NJ 07050 SUSPENSION 5/20/2008 TECH YAW, GAYFORD A. PHARM 5/11/1963 504 STEVENS ROAD LANDING NJ 07850 DISQUALIFICATION 9/24/2008 TECH YELCICK, JOHN MD 5/15/1965 635 WILLOW GREEN LITITZ PA 17543 DEBARMENT 7/28/2014 YEN, YA-TANG MD 5/8/1944 1952374530 2 FAWN PATH HOLMDEL NJ 07733 DISQUALIFICATION 8/21/2019 PERMANENT YEPES, LINA CHHA 1/19/1980 2105 NEW YORK AVENUE, UNION CITY NJ 07087 DISQUALIFICATION 2/20/2017 BSMT 3 YEPES-SANCHEZ, ONAIDA CHHA 10/9/1961 1815 PALLISADE AVENUE UNION CITY NJ 07086 DISQUALIFICATION 2/8/2017

YOON, TOL UNG MD 2/15/1941 9 MALAGA DRIVE BRIDGETON NJ 08302 DISQUALIFICATION 12/1/1998 YOUNG, JULIA CHHA 9/9/1975 2019 SOUTH 9TH STREET CAMDEN NJ 08104 DISQUALIFICATION 2/20/2017 YOUNGER, ANTHONY 11/24/1969 65 MAIDEN LANE LITTLE FERRY NJ 07643 DEBARMENT 10/15/2008 YULE, ROBERT C. RN 6/23/1948 323 FLORENCE ROAD MIDDLETOWN NJ 07748 SUSPENSION 9/19/2003 YUNATANOV, STEVE DDS 4/7/1965 1366749962 83-83 118 TH STREET KEW GARDENS NY 11415 SUSPENSION 7/20/2004 ZAINELABDIN, AMID 12/12/1950 126 CORBIN AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 5/21/2002 ZAK, FELIX 4/13/1952 825 E. 9TH STREET BROOKLYN NY 11230 DISQUALIFICATION 1/9/2001 ZAMAN, TANVIR PHARM 9/25/1980 205 DAVIS AVENUE ABSECON NJ 08201 DISQUALIFICATION 7/18/2018 TECH ZAMLOOT, PHILIP 10/28/1969 150 PARK ROW NEW YORK NY 10007 SUSPENSION 7/20/2005 ZARRELLI, MICHAEL 12/13/1966 FCI FORT DIX - PO BOX 2000 JOINT BASE MDL NJ 08640 DISQUALIFICATION 9/29/2017 #67206-050 ZASLOW, LAWRENCE RPH 12/7/1953 323 SOCIETY HILL CHERRY HILL NJ 08003 DISQUALIFICATION 10/25/2016 BOULEVARD, APT 1 ZAWAHIR, MEEYAPILLAI 2/22/1939 91 KNICKERBOCKER ROAD TENAFLY NJ 07670 SUSPENSION 9/20/2006

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PROVIDER NAME TITLE DATE OF NPI NUMBER STREET CITY STA ZIP ACTION EFFECTIVE EXPIRATION BIRTH TE DATE DATE ZELTSER, LAZAR 4/11/1973 2333 MORRIS AVENUE, UNIT UNION NJ 07083 SUSPENSION 6/22/1998 D3 ZELTSER, RAISA 9/11/1970 6 PLEASANT VALLEY WAY WEST ORANGE NJ 07079 SUSPENSION 9/14/2000 ZERKTI, HOUDA CHHA 7/26/1982 72 KENNEDY BOULEVARD BAYONNE NJ 07002 DISQUALIFICATION 2/8/2017 ZIBDIE, YOUSEF MD 5/5/1964 1598714784 163 WEBSTER DRIVE WAYNE NJ 07470 DEBARMENT 12/11/2017 ZIBDIE, YOUSEF MD 5/5/1964 1598714784 871 MCBRIDE AVENUE, SUITE WOODLANE PARK NJ 07424 DISQUALIFICATION 8/20/2018 1 ZIHALA, TERESA RN 7/25/1961 148 MAIN STREET SPOTSWOOD NJ 08884 SUSPENSION 9/19/2003 ZIMMERMAN, DANIEL MD 10/13/1947 1801919741 51 ROCKLEDGE ROAD HAWTHORNE NJ 07506 DEBARMENT 12/7/1999 9/5/2012 ZIMMERMAN, DANIEL MD 10/13/1947 1801919741 501 BARCLAY WALK CHERRY HILL NJ 08034 DISQUALIFICATION 11/23/2016 ZIMNA, GRAZYNA CHHA 3/14/1963 19 NEW JERSEY AVENUE CARTERET NJ 07008 DISQUALIFICATION 2/20/2017 ZUBAIR, SAIRA 3/1/1971 18 RAVENSWOOD LANE SCOTCH PLAINS NJ 07076 DEBARMENT 8/1/2017 ZUBERI, REHAN 1/4/1969 FLUSHING NY 11355 DEBARMENT 2/18/1999 11/17/2011 ZUBERI, REHAN 1/4/1969 MID-STATE CORRECTIONAL WRIGHTSTOWN NJ 08562 DISQUALIFICATION 2/28/2018 PERMANENT FACILITY, PO BOX 866 ZUCKERMAN, DAVID H. DPM 4/11/1954 1124024435 341 S. EVERGREEN AVENUE WOODBURY NJ 08096 DEBARMENT 1/15/2012 ZUCKERMAN, DAVID H. DPM 4/11/1954 1124024435 1803 COUNTRY CLUB DRIVE CHERRY HILL NJ 08003 DISQUALIFICATION 9/20/2012

ZUNIGA, GUISELLA CHHA 1/12/1980 74B WEST SECOND STREET BOUND BROOK NJ 08805 DISQUALIFICATION 5/8/2018 PERMANENT ZWIERCAN, ANDREW RPH 6/19/1957 601 BERGEN STREET SOUTH PLAINFIELD NJ 07080 DEBARMENT 6/20/2016

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