State of New Jersey Medicaid Fraud Division Provider ... · ahmad, abadullah 4/3/1984 280 louis...

State of New Jersey

Medicaid Fraud Division

Provider Exclusion Report**ADDITIONAL NPI NUMBERS MAY BE ASSOCIATED WITH THE LISTED INDIVIDUALS/ENTITIES**

1

Updated on: 8/24/2018

PROVIDER NAME TITLE DATE OF

BIRTH

NPI NUMBER STREET CITY STATE ZIP ACTION EFFECTIVE

DATE

EXPIRATION

DATE

2258 PHARMACY, INC. 2258 THIRD AVENUE NEW YORK NY 10035 SUSPENSION 7/20/2003

6522 VENTNOR AVE.

PHARMACY, INC.

6522 VENTNOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION

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

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 ST., APT. 1 WOODSIDE NY 11377 SUSPENSION 9/20/2005

ABRAHAMSEN, SVEND DPM 9/17/1944 101 CHESTNUT RIDGE RD. SADDLE RIVER NJ 07458 DISQUALIFICATION 4/20/1994

ABRAMS, IRVING RPH 12/23/1949 5 LORGENE WAY MORGANVILLE NJ 07551 SUSPENSION 4/27/2000

ABREU MARTINEZ,

CAROLINA

CHHA 12/14/1989 14 EAST RUSSELL STREET CLIFTON NJ 07011 DEBARMENT 10/31/2017

ABUSEF, ELSAYED K. SUTEX

MED.

TRANSPO

RT

814 74TH STREET NORTH BERGEN NJ 07047 DISQUALIFICATION 5/20/1999

AC HOME NURSING 1235230665 2921 YOUNGSTOWN RD. WARREN OH 44484 DISQUALIFICATION 11/20/2015

For verifications

please contact: [email protected] Send an email to [email protected] to receive this report in .xls format

State of New Jersey



2



BIRTH


DATE

EXPIRATION

DATE

ACKLEY, GEORGE PSYCH 5/13/1944 1457535833 202 LENOX AVENUE CAPE MAY NJ 08204 DEBARMENT 7/21/2015

ACOSTA, PEDRO E. 1/23/1945 5815 43RD AVENUE WOODSIDE NY 11377 SUSPENSION 4/13/2008

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 FL WOODSIDE NY 11377 DISQUALIFICATION 9/16/2011

ACOSTA, WILLIAM R. MD 8/24/1949 47 OSBORNE STREET JOHNSTOWN PA 15905 DISQUALIFICATION 11/20/2015

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 RD. MOUNT LAUREL NJ 08054 DISQUALIFICATION 9/20/2011 11/23/2016

ADAIR, LISA AKA

TARASEVICH, LISA

LPN 4/20/1961 206 LAKEHURST AVENUE,

APT. B

NATIONAL PARK NJ 08063 SUSPENSION 9/19/2002

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 CT. HS NJ 08210 SUSPENSION 6/19/2003

ADAMSHICK, WILLIAM RPH 10/9/1960 1871842575 2516 HURRY RD. 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 MAIMI FL 33177 DISQUALIFICATION 12/12/2016

ADES, ALBERT (DR.'S

OFFICE)

1447560867 129 MADISON AVENUE CRESSKILL NJ 07626 DISQUALIFICATION 6/16/2017

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, KWABENA CHHA 2/19/1975 3 AUGUSTA DRIVE LITTLE EGG HARBOR NJ 08087 DISQUALIFICATION 1/23/2018

AFRIYIE, BRIGHT CHHA 6/20/1994 317 W. RUNYON STREET, 3L NEWARK NJ 07108 DISQUALIFICATION 1/23/2018

For verifications


State of New Jersey



3



BIRTH


DATE

EXPIRATION

DATE

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

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, ROBERT MD 4/11/1957 1619155710 15 BARBERRY WAY ESSEX FALLS NJ 07021 DISQUALIFICATION 6/26/2018

AGUIAR, SANDRA 2/3/1967 605 KNICKERBOCKER RD. 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,

CANDIDA

10/24/1915 40 FERRY STREET NEWARK NJ 07105 DEBARMENT 7/12/1999

AGYEMANG, JOHN RPH 2/18/1969 1487934626 153 BLUE MEADOW LANE SICKLERVILLE NJ 08081 DISQUALIFICATION 12/28/2016

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 BLVD #15 JERSEY CITY NJ 07302 SUSPENSION 2/19/2009

AHMAD, FAROOQ RPH 10/1/1943 1659605590 300 EAST HALSEY RD. 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-2MN JERSEY CITY NJ 07306 SUSPENSION 5/30/1997

AHMED, KHALID H. 2/6/1963 PO BOX 930 NEW YORK NY 10013 DISQUALIFICATION 3/26/1994

AHMED, MOHAMED G. PHARM

TECH

7/14/1989 5 WESTOVER TERRACE WEST ORANGE NJ 07052 DISQUALIFICATION 8/20/2010

AIRD, EILEEN, B. 6/28/1950 295 GRANDVIEW CIRCLE RIDGEWOOD NJ 07450 SUSPENSION 4/20/2003

For verifications


State of New Jersey



4



BIRTH


DATE

EXPIRATION

DATE

AKANDE, EZEKIEL MD 1/15/1959 1003859885 300 HAIL KNOB ROAD,

#290828

SOMERSET KY 42503 DISQUALIFICATION 9/20/2017

AKHMEDOV, KHUSEN 8/1/1990 SCI GRATERFORD, ME9849,

PO BOX 244

GRATERFORD PA 19426 DISQUALIFICATION 11/20/2015

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 BLVD JERSEY CITY NJ 07305 SUSPENSION 5/1/2011

AL SALIHI, FAROUK MD 7/1/1934 1720158025 1810 JOHN F. KENNEDY BLVD JERSEY CITY NJ 07305 DEBARMENT 1/9/2015

ALAMEEN, ALWALEED TEMPT

TRANS

5/16/1968 238 MAIN STREET HACKENSACK NJ 07601 SUSPENSION 7/18/1995

ALAN, DAVID OD 7/26/1946 1225012073 203 NORTH REDWOOD ST MASONTOWN PA 15461 DISQUALIFICATION 11/20/2015

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


ALCAIDE, KELLEY LPN 2/4/1969 716 RIVER RD. SOMERVILLE NJ 08844 SUSPENSION 2/20/2002

ALEXANDER, EDWARD J. MD 6/4/1955 8001 CASTOR AVENUE, STE.

326

PHILADELPHIA PA 19152 DEBARMENT 8/8/2000

ALEXANDER, JULIE B. RPH 8/20/1972 1525 DOGWOOD DRIVE CHERRY HILL NJ 08003 SUSPENSION 5/19/2005

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

For verifications


State of New Jersey



5



BIRTH


DATE

EXPIRATION

DATE

ALI, HANIFAH CHHA 12/3/1990 1216 FALCON DRIVE ABSECON NJ 08201 DISQUALIFICATION 2/20/2017

ALI, MOHAMED MD 4/18/1954 64 BEVAN STREET JERSEY CITY NJ 07306 DISQUALIFICATION 5/31/1994

ALI, SAQIB 3/14/1954 MDC BROOKLYN, PO BOX

3290

BROOKLYN NY 11232 DEBARMENT 5/20/2012

ALI, TARK TARK

TRANS

566 BLOOMFIELD AVENUE BLOOMFIELD NJ 07306 DISQUALIFICATION 5/10/1999

ALLEN, ADINA CHHA 8/21/1979 219 PINEBROOK DRIVE MANTUA NJ 08051 DISQUALIFICATION 5/22/2017

ALLEN, KENNYATTA G. 1/14/1976 148 CORNERSTONE PLACE WHITEHALL PA 18052 DISQUALIFICATION 3/14/2008

ALLEN-BROGAN, MELANIE

A.

8/1/1984 135 WILD OAKS COURT LITTLE EGG HARBOR NJ 08701 SUSPENSION 3/5/2008

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

CORPORATION

PO BOX 1011 UNION NJ 07083 DISQUALIFICATION 4/3/2000

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

ALSTON, SHERRELLE 12/11/1970 NORTH 52ND STREET PHILADELPHIA PA 19139 DEBARMENT 10/9/2007

ALVIS, SANDRA CHHA 5/29/1955 1421 HOLLINSHED AVENUE PENNSAUKEN NJ 08110 SUSPENSION 5/19/2005

ALY, ABUBAKR CRESCEN

T TRANS

5/26/1955 24 BRANFORD PLACE NEWARK NJ 07102 DISQUALIFICATION 3/11/2004

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

For verifications


State of New Jersey



6



BIRTH


DATE

EXPIRATION

DATE

AMABILE, JOHN C. OD 4/23/1962 HIGHWAY #35 & 3RD AVENUE OCEAN NJ 07712 DISQUALIFICATION 6/30/2002

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, 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 RD. YORKVILLE CA 95494 DISQUALIFICATION 10/20/2009

AMATO, VANESSA A. AKA

VANESSA A. NOWINSKI

RN 3/21/1977 65 LOCUST AVENUE N. ARLINGTON NJ 07031 SUSPENSION 9/19/2003

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.

14W

IRVINGTON NJ 07111 DISQUALIFICATION 2/20/2017

AMERICAN EXPRESS LOAN,

INC.

1386883239 13420 DAMAR DRIVE, SUITE C PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015

AMERICAN MED. TECH.,

INC.

1072 MADISON AVENUE LAKEWOOD NJ SUSPENSION 4/14/1999

AMERICAN MEDICAL

EXPRESS AMBULANCE, LLC.

1205071883 PO BOX 3093 WARMINSTER PA 18974 DISQUALIFICATION 11/20/2015

AMIN, PRISCILLA CHHA 6/18/1990 133 ATLANTIC STREET HACKENSACK NJ 07601 DEBARMENT 10/23/2017

AMPARO, VIANNE CHHA 10/2/1982 710 EAST 18TH STREET PATERSON NJ 07501 DISQUALIFICATION 1/31/2017

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, SUBINA DDS 8/30/1967 1982781589 17 GROVERS MILL RD. PLAINSBORO NJ 08536 DISQUALIFICATION 12/20/2012

For verifications


State of New Jersey



7



BIRTH


DATE

EXPIRATION

DATE

ANAND, SUBINA DDS 8/30/1967 1982781589 17 GROVERS MILL RD. PLAINSBORO NJ 08536 DISQUALIFICATION 4/17/2012

ANDAS PHARMACEUTICAL

SUPPLY CORP.

592 PALISADE AVENUE TEANECK NJ 07666 DISQUALIFICATION 5/20/2018

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

ANDERSON, NICOLE RN 8/27/1986 1801 HUNTINTON MEWS CLEMONTON NJ 08021 DISQUALIFICATION 8/28/2017

ANDRADE, GLORIA LCSW/LC

ADC

9/18/1962 1992804850 679 GRANT TERRACE TEANECK NJ 07666 SUSPENSION 6/18/2018

ANDUJAR, EDWARD MD 12/23/1955 516 E. WOOD STREET VINELAND NJ 07410 DISQUALIFICATION 1/20/2006

ANELLO, ALLYSON PHARM

TECH

9/30/1984 708 FOX HILL DRIVE DOVER NJ 07801 DISQUALIFICATION 2/5/2018 PERMANENT

ANGEL, CHRISTINA CHHA 5/9/1989 145 PRESIDENTIAL

BOULEVARD, APT. 16J

PATERSON NJ 07522 DISQUALIFICATION 2/20/2017

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 RD. 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

ANTHONY, QUINT LPN 4/7/1956 900 BARNEGAT BLVD. N #908 BARNEGAT NJ 08005 DISQUALIFICATION 6/5/2017

ANTONE, JULIE LCSW 8/9/1980 366 CAMBRIDGE DRIVE RAMSEY NJ 07446 DEBARMENT 2/20/2013

APONTE, DENNIS MD 9/23/1966 1053458018 MDC BROOKLYN, PO BOX

329002

BROOKLYN NY 11232 DISQUALIFICATION 5/20/2015

AQUILANTE, JOHN C. RPH 8/13/1946 27 ROCKLEDGE PLACE CEDAR GROVE NJ 07009 DISQUALIFICATION 9/23/1983

ARDAN, MARGO RN 8/5/1963 161 CONAWAGA TRAIL MEDFORD NJ 08055 DISQUALIFICATION 6/28/2017

For verifications


State of New Jersey



8



BIRTH


DATE

EXPIRATION

DATE

ARDEHALI, MOHAMMAD MD 12/19/1944 193 ELWOOD AVENUE NEWARK NJ 07104 SUSPENSION 2/20/2001

ARGUETA, ALVARO PSYCH 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

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 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

ASTON, ALEXIA L. LPN 2/12/1980 15 PRIMROSE LANE, APT. 3 DELRAN NJ 08075 DISQUALIFICATION 6/18/2009

ATIENZA, CESAR P. MD 12/12/1943 1164491494 56 COLD INDIAN SPRING RD OCEAN NJ 07712 DISQUALIFICATION 8/6/1991

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

AVENUE

ATLANTIC CITY NJ 08401 DISQUALIFICATION 6/6/2018

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

AZAM, CHOWDHURY F. MD 7/1/1954 1922053792 38 ORIOLE DRIVE HACKETTSTOWN NJ 07840 DEBARMENT 2/1/1999 6/30/2015

For verifications


State of New Jersey



9



BIRTH


DATE

EXPIRATION

DATE

AZAM, CHOWDHURY F. MD 7/1/1954 1922053792 30 DUNSTON LANE MONMOUTH

JUNCTION

NJ 08852 DEBARMENT 10/26/2016

AZIZ-DURRANI, MUMLIKAT 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

BABARIA, ASHOKKUMAR R. MD 2/23/1950 1538100599 208 QUAKERBRIDGE COURT MOORESTOWN NJ 08057 SUSPENSION 1/10/2012

BABARIA, ASHOKKUMAR R. MD 2/23/1950 1538100599 5756 HARTFIELD/POINTVILLE FORT DIX NJ 08640 DISQUALIFICATION 2/28/2015

BACSENKO, JENNIFER PHARM

TECH

3/18/1976 103 STATE STREET LINWOOD NJ 08221 SUSPENSION 1/20/2011

BADAWY, BADAWY MD 12/27/1962 1679615553 2738 JOHN F. KENNEDY BLVD.

1ST FL

JERSEY CITY NJ 07306 DISQUALIFICATION 2/11/2016

BADAWY, BADAWY MD 12/27/1962 1679615553 2738 KENNEDY BLVD. 1ST FL JERSEY CITY NJ 07306 SUSPENSION 3/25/2013

BADO, JEFFREY DO 8/27/1955 1801908173 1615 ASHBOURNE RD. ELKINS PARK PA 19027 DISQUALIFICATION 11/20/2015

BADO, JEFFREY #71927-

066

DO 8/27/1955 1801908173 FDC PHILADELPHIA, PO BOX

562

PHILADELPHIA PA 19105 DISQUALIFICATION 11/20/2017

BADUINI, JOLIE RN 6/26/1989 1300 32ND AVENUE SW, APT.

307

MINOT ND 58701 DISQUALIFICATION 5/20/2015

BAER, MICHAEL L. DC 6/12/1953 1053654616 BAYSIDE STATE PRISON LEESBURG NJ 08327 SUSPENSION 9/20/2004

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

For verifications


State of New Jersey



10



BIRTH


DATE

EXPIRATION

DATE

BAGDASAROVA, ANGELICA RN 7/17/1964 11981 AUDUBON AVENUE PHILADELPHIA PA 19116 DISQUALIFICATION 11/20/2015

BAH, HUSAINATU 9/9/1988 2510 BIRCHWOOD COURT NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 1/15/2016

BAH, HUSAINATU 9/9/1988 2510 BIRCHWOOD COURT NORTH BRUNSWICK NJ 8902 DISQUALIFICATION 11/28/2013

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 SQ. PLACE LANSDALE PA 19446 SUSPENSION 5/20/2004

BAJAKIAN, BRYAN DC 6/22/1959 1679618094 3105 STOWE LANE MAHWAH NJ 07430 DISQUALIFICATION 10/18/2010

BAJWA, LATIF AHMAD ACCUPU

NCTURIST

5/7/1948 PO BOX 633 LANGHORNE PA 19047 SUSPENSION 2/9/2009

BAKER, SCOTT CNA 3/31/1972 215 BURLINGTON RD. SOUTH BRIDGETON NJ 08302 DISQUALIFICATION 5/24/2002

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 RD., APT. 736 GREAT NECK NY 11023 DISQUALIFICATION 7/26/2011

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

For verifications


State of New Jersey



11



BIRTH


DATE

EXPIRATION

DATE

BAPTISTE, STANLEY CHHA 1/17/1992 401 WEST VIRGINIA AVENUE,

APT B-16

NEPTINE NJ 07753 DISQUALIFICATION 4/19/2018

BARAHONA, RONY 8/9/1962 549 SUMMIT AVENUE MAPLEWOOD NJ 07040 DEBARMENT 3/26/2013

BARAN-DICRISCIO,

LORRAINE

CHHA 12/3/1939 309 IRIS RD. CHERRY HILL NJ 08620 SUSPENSION 3/20/2002

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

BARATTI, CARMEN DO 7/16/1934 150 KIRKBRIDGE RD. 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,

JENNIFER

12/10/1969 8 ELKRIDGE PARKWAY MANALAPAN NJ 07726 SUSPENSION 11/5/2009

BARDEN, BRENDA RN 7/5/1955 19 INTERVALE RD. 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 RD. EWING NJ 08618 DEBARMENT 9/16/2011 9/17/2014

BARON, MICHAEL B. MD 2/27/1947 SE 1256 BISHOP BLVD., STE1 PULMAN WA 99163 DEBARMENT 9/11/2000

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

BARTLOW, BRIAN 3/3/1960 551 PARKWOOD AVENUE TOMS RIVER NJ 08753 SUSPENSION 7/17/2003

BASBUS, VIICTOR M. MD 7/18/1944 1811098858 33 5TH AVENUE, APT. 1B NEW YORK NY 10003 DEBARMENT 2/6/2009

For verifications


State of New Jersey



12



BIRTH


DATE

EXPIRATION

DATE

BASSO, NICHOLAS V. MD 12/13/1945 7665 MAPLE AVENUE PENNSAUKEN NJ 08109 DEBARMENT 2/1/2000

BATARSEH, BASEL MD 5/12/1960 1063602696/

1891803318

620 FAIRLAWN AVENUE GLEN ROCK NJ 07410 DEBARMENT 12/31/2017

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

BOULEVARD, APT. 4D

NEWARK NJ 07108 DISQUALIFICATION 2/20/2017

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 7305 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,

AMY

CHHA 1/11/1992 201 WEBSTER STREET WOODBINE NJ 08270 DISQUALIFICATION 1/17/2018 8/20/2018

BEALS, PAUL V. MD 4/15/1943 1427175652 4120 WESTFIELD AVENUE PENNSAUKEN NJ 08110 SUSPENSION 6/24/2014

BECK, ALLAN G. MD 2/5/1944 1833 ARROWHEAD DRIVE WATERFORD NJ 08089 SUSPENSION 2/20/2001

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 SUSPENSION 6/8/2016

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

For verifications


State of New Jersey



13



BIRTH


DATE

EXPIRATION

DATE

BELL, SHANNON PHARM

TECH

2/23/1979 6591 MILL ROAD EGG HARBOR

TOWNSHIP


BELLAMY, BERNICE 5/24/1957 1 CRISPIN ROAD LUMBERTON NJ 08060 DEBARMENT 10/20/2004

BELLAMY, HARVEY H&B

TRANS.

9/30/1962 CRAF PO BOX 7450 TRENTON NJ 08625 DISQUALIFICATION 10/20/2004

BELLO, REY N. MD 11/18/1957 1780796409 444 60TH STREET WEST NEW YORK NJ 07093 SUSPENSION 1/31/2011 PERMANENT

BELMAR HOMETOWN

PHARMACY

911 MAIN STREET BELMAR NJ 07719 SUSPENSION 2/5/2003

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

TECH

12/27/1986 FCI DANBURY RT 37, #60674-

050

DANBURY CT 06811 DISQUALIFICATION 9/18/2009

BENNETT, SHARON CHHA 9/27/1954 736 EDGEWOOD AVENUE TRENTON NJ 08618 DISQUALIFICATION 1/31/2017

BENNETT-WILLIAMSON,

KATHLEEN

LPN 7/12/1951 75 WALT WHITMAN WAY TRENTON NJ 08690 DISQUALIFICATION 8/27/2001

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

BERGER, SHELDON H. MD 5/26/1929 1032 ROUTE 34 MATAWAN NJ 07747 DEBARMENT 9/30/2000

BERKELHAMMER, EDWARD MD 12/18/1941 230 W. JERSEY ST. ELIZABETH NJ 07202 DISQUALIFICATION 8/30/1990

BERKS PSYCHIATRY 1104949149 146 SOUTH 5TH STREET READING PA 19602 DISQUALIFICATION 11/20/2015

BERMAN, LARRY R. DDS 12/14/1953 1326191347 308 RARITAN DRIVE 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

BEST, ALEXANDER C. 3/19/1969 PO BOX 7000 FORT DIX NJ 08640 SUSPENSION 7/20/2005

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

For verifications


State of New Jersey



14



BIRTH


DATE

EXPIRATION

DATE

BEYNON-SERFASS, LEONOR RN 12/11/1963 18 WILSON AVENUE CLARKS SUMMIT PA 18411 DISQUALIFICATION 11/30/2017

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

BIENSTOCK, DOUGLAS DO 6/27/1966 1831151356 245 DIAMOND BRIDGE

AVENUE

HAWTHORNE NJ 07506 DEBARMENT 12/16/2015

BIENSTOCK, DOUGLAS DO 6/27/1966 1831151356 245 DIAMOND BRIDGE

AVENUE

HAWTHORNE NJ 07506 DISQUALIFICATION 5/12/2016

BILENKIN, ELANA 8/19/1969 242 COMUNITY CIRCLE OLD BRIDGE NJ 08857 DISQUALIFICATION 4/15/1998

BINDER, RANDY RPH 2/19/1953 1972526572 FCI 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

SERVICES

1407923568 181 NEW STREET PARSIPPANY NJ 07054 SUSPENSION 1/21/2015

BIONDELLO JR., PHILIP 9/8/1966 41 CONCORD LANE BASKING RIDGE NJ 07920 DISQUALIFICATION 7/20/2017

BIO-SCIENCE LAB, INC. 1000 WOODBRIDGE COURT WOODBRIDGE NJ 07095 DEBARMENT 3/20/2000

BISHARA, GIRGIS MD 12/23/1921 859 BRIGHTON PL. OCEAN CITY NJ 08226 DISQUALIFICATION 1/17/1987

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

GEO DRIVE

PHILLIPSBURG PA 16866 DISQUALIFICATION 11/30/2017 PERMANENT

BLACKMAN, NOEL MD 12/18/1947 1720209521 MOSHANNON VALLEY CI, 555

GEO DRIVE

PHILLIPSBURG PA 16866 DISQUALIFICATION 3/26/2017 PERMANENT

BLANCO, ALEX DPM 2/21/1972 1881677987 180 LAFAYETTE AVENUEM

APT. 12A

PASSAIC NJ 07055 DISQUALIFICATION 8/24/2017

BLANCO, LAZARO PHARM

TECH

12/26/1990 401 46TH STREET, APT. 5 UNION CITY NJ 07087 DISQUALIFICATION 8/28/2017

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

For verifications


State of New Jersey



15



BIRTH


DATE

EXPIRATION

DATE

BLEIMAN, MICHAEL MD 8/24/1961 1821086463 1100 ROUTE 72 WEST, SUITE

304

MANAHAWKIN NJ 08050 SUSPENSION 1/27/2017 4/27/2017

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 AVE., 3RD

FL


BLYN, CHARLOTTE MD 11/18/1928 1669700910 511 WINDING WAY MERION STATION PA 19066 DISQUALIFICATION 11/20/2015

BMA MEDICAL

LABORATORY

59-07 71ST AVENUE RIDGEWOOD NY 11385 SUSPENSION 10/20/2003

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

BOBADILLA, MARIA CHHA 6/2/1969 85 PRESIDENTIAL

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

BOEHM, GREGORY MD 6/4/1949 1972678894 26777 LORAIN AVENUE, SUITE

716

NORTH OLMSTEAD PA 44070 DISQUALIFICATION 11/20/2015

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

JOHN

RN 12/8/1961 2701 NW 23 BLVD, APT. 225 GAINESVILLE FL 32605 DISQUALIFICATION 8/20/2015

BOND, CLIFTON MD 9/5/1956 418 JAMESTOWN COURT MT. LAUREL NJ 08054 DISQUALIFICATION 2/21/1992

BONDAR, SOFIYA DDS 8/24/1954 1952355158 2815 COYLE ST. APT. 210 BROOKLYN NY 11235 DISQUALIFICATION 11/18/2011

For verifications


State of New Jersey



16



BIRTH


DATE

EXPIRATION

DATE

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 RD MONROE NJ 08831 SUSPENSION 2/20/2002

BONSU, ACHIAA CHHA 1/20/1982 1414 BIRCHWOOD COURT NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 7/14/2017

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 N. 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 THERAPIS

T

5/17/1958 PO BOX 1288 MCAFEE NJ 07428 SUSPENSION 9/19/2002

BORNSTEIN, KATHLEEN LPN 12/29/1963 136 73RD STREET NORTH BERGEN NJ 07047 SUSPENSION 2/19/2004

BOROWEC, LAWRENCE W. MD 7/22/1952 202 STOTESBURY AVENUE NEWFIELD NJ 08344 DISQUALIFICATION 12/1/1998

BOROWEC, LAWRENCE W. MD 7/22/1952 202 STATESBURG 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

TECH

1/25/1985 13 SWEET BRIAR DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 11/21/2016 4/5/2018

BOSTICK, MICHELLE CHHA 6/16/1962 87 TILLINGHAST STREET NEWARK NJ 07108 DISQUALIFICATION 2/20/2017

BOTTENBLEY, CECIL J. DMD 6/6/1950 16 FIRESIDE CT. WILLINGBORO NJ 08046 DISQUALIFICATION 4/9/1987

BOUCHE, JASON 7/16/1984 6641 E. MEADOWLARK LANE PARADISE VALLEY AZ 85253 DISQUALIFICATION 5/20/2012

For verifications


State of New Jersey



17



BIRTH


DATE

EXPIRATION

DATE

BOULOS-PLUDOWSKI,

GEORGEANN

RPH 1/20/1958 493 RINGWOOD AVENUE PHILLIPSBURG NJ 08865 SUSPENSION 5/19/2005 3/11/2013

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

ORTHODONTIST

288 HIGHWAY 35 SOUTH EATONTOWN NJ 07724 SUSPENSION 8/20/2003

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 RD. SMYRNA DE 19977 DISQUALIFICATION 10/20/2012

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


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

BRETTLER, NORMAN AKA

BRETTLER, NORBERT

2/3/1948 401 COUNTRY CLUB DRIVE CHERRY HILL NJ 08003 DISQUALIFICATION 5/12/2016

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

For verifications


State of New Jersey



18



BIRTH


DATE

EXPIRATION

DATE

BRISTOL, KENNETH RN 1/2/1951 PO BOX 931 FLAGSTAFF AZ 06002 SUSPENSION 10/19/2006

BRIZER, DAVID ALLEN MD 1/22/1953 1518181270 255 W 85TH ST., APT. 5B NEW YORK NY 10024 DISQUALIFICATION 6/30/2014

BRIZER, DAVID ALLEN MD 1/22/1953 1518181270 6766 108TH STREET, APT. A62 FOREST HILLS NY 11375 DISQUALIFICATION 2/20/2015

BROADNAX, DEITRICH 7/12/1965 347 BELLEVILLE AVE., #B8 BLOOMFIELD NJ 07003 DISQUALIFICATION 11/25/1998

BROADWAY MEDICAL

GROUP

227 BROADWAY PATERSON NJ 07501 DISQUALIFICATION

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 COUNSEL

OR

11/8/1963 27 E VILLAGE OF STONEY RD MAPLE SHADE NJ 08052 DISQUALIFICATION 4/17/1995

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, 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.

#4-F

PATERSON NJ 07524 DEBARMENT 10/26/2017

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

For verifications


State of New Jersey



19



BIRTH


DATE

EXPIRATION

DATE

BRUGOS, LEALYNN CHHA 1/31/1994 636 BILLINGS AVENUE PAULSBORO NJ 08066 DISQUALIFICATION 1/31/2017

BRUNELLE, ELIZABETH LPN 10/13/1950 5902 EAST 2ND STREET TUCSON AZ 85711 SUSPENSION 10/19/2006

BRYANT-DERRICK, KISHARA 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 RD. 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

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

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

TECH

11/30/1952 1407 VIRGINIA COURT MARLTON NJ 08053 SUSPENSION 4/20/2011

BURNETT, RASHEEDAH CHHA 1/26/1983 860 SOUTH 11TH STREET,

APT. 4-B


BURNS, MARGARET 12/9/1952 2429 WESTFIELD AVENUE SCOTCH PLAINS NJ 07076 SUSPENSION 9/19/2003

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

BUTT, ATIQ 2/2/1959 2524 FORD RD. 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

For verifications


State of New Jersey



20



BIRTH


DATE

EXPIRATION

DATE

BYADGI, CHETHAN MD 8/8/1963 1063537215 LACKAWANNA COUNTY

PRISON, 1371 NORTH

WASHINGTON AVENUE

SCRANTON PA 18509 DISQUALIFICATION 7/20/2017

BYERS, RAYMOND AKA

BYERS, FAYE

R & B

TRANS

2/6/1943 44 PALM STREET, FL. 2 NEWARK NJ 07106 DEBARMENT 10/14/2005

CABALEIRO, YODALIO MD 12/3/1930 3700 KENNEDY BLVD. 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

CABATIC, VIRGINIA C. RN 6/11/1940 14 SPARROW RD. RANDOLPH NJ 07869 SUSPENSION 5/19/2005

CABRERA, RAMON BRETON 6/29/1959 486 ZAMBORY STREET PERTH AMBOY NJ 08861 DEBARMENT 9/19/2011

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 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

CALDERON, TANISHA CHHA 11/26/1977 108 N. 16TH EAST ORANGE NJ 07019 SUSPENSION 3/20/2002

CALLAHAN, VICTORIA PHARM

TECH

5/23/1979 130 FROST AVENUE PHILLIPSBURG NJ 08865 DISQUALIFICATION 7/21/2017 PERMANENT

CALVELO, ARSENIO C. RN 3/15/1953 13515 SCENIC GLADE DR. 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,

DONNA

LPN 2/12/1970 1355 W. POINT AVENUE MAYS LANDING NJ 08330 DISQUALIFICATION 4/10/2018

For verifications


State of New Jersey



21



BIRTH


DATE

EXPIRATION

DATE

CAMPBELL JR., HIGHLAND MD 11/26/1966 1043270143 1009 MEADOWVIEW LANE MONT CLARE PA 19453 DISQUALIFICATION 11/20/2015

CAMPIONE JR., FRANK PA 3/10/1970 1598856924 431 STONEY POINT ROAD BRICK NJ 08733 DISQUALIFICATION 9/16/2016

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.

2B

SOMERVILLE NJ 08876 DISQUALIFICATION 5/2/2018

CANE, LAMONT NURSES

AIDE

PO BOX 90431 CAMDEN NJ 08012 SUSPENSION 8/18/1997

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-

12

BRADLEY BEACH NJ 7720 DISQUALIFICATION 4/18/2017

CANTERMEN, LYNN RN 11/3/1975 518 N. HILDEBRAND AVENUE GLENDORA NJ 8029 DISQUALIFICATION 5/2/2018

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 SCHUYLKILL FCI, PO BOX 759 MINERSVILLE PA 17954 DISQUALIFICATION 11/20/2015

CAPO. LASARAH CHHA 9/22/1988 50-52 ROSA PARK

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 RD. KINNELON NJ 07504 DISQUALIFICATION 7/18/2001

CARCHIA, ETTORE DC 8/21/1960 994 SANDY CIRCLE MANAHAWKIN NJ 08050 SUSPENSION 2/20/2006

CARDENAS, PRESENTACION

E.

RN/LPN 11/21/1953 274 BATH AVENUE, #22 LONG BRANCH NJ 07740 SUSPENSION 5/20/2001

For verifications


State of New Jersey



22



BIRTH


DATE

EXPIRATION

DATE

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 RD. 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 FORT DIX NJ 08640 DISQUALIFICATION 2/3/2014

CAREPOINT MEDICAL 1396744694 4860 COX RD., 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 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

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 RD. LUMBERTON NJ 08048 SUSPENSION 3/2/2011

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

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

For verifications


State of New Jersey



23



BIRTH


DATE

EXPIRATION

DATE

CARUSO, EDMUND M. DMD 7/30/1958 1811132442 2275 KENNEDY BLVD. 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

FAMILY

MEDICAL

4/8/1949 4300 SW 57TH STREET MIAMI FL 33155 SUSPENSION 6/17/2004

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 PO BOX 16421 JERSEY CITY NJ 07306 DISQUALIFICATION 5/5/1997

CATANZARO, DANIEL DC 10/19/1959 28 ETOWAH RIDGE DRIVE, SW CARTERSVILLE GA 30120 SUSPENSION 12/20/2005

CATANZARO, VINCENT F. MD 5/22/1947 560 MAIN STREET ALLENHURST NJ 07711 DISQUALIFICATION 6/1/1993 DECEASED

CAVALLI, DEAN 762 BROADWAY CAMDEN NJ 08103 DISQUALIFICATION

CAVE, SANDY 3/10/1972 109 BOBWHITE RD. 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

LAB

256 SMITH STREET PERTH AMBOY NJ 08861 DISQUALIFICATION 5/8/1989

CENTRAL JERSEY MENTAL

CENTER

525 PARK AVENUE PLAINFIELD NJ 07067 DISQUALIFICATION

CENTRELLI, MARC DC 8/1/1960 176 ALPINE TRAIL SPARTA NJ 07871 SUSPENSION 7/21/2008

For verifications


State of New Jersey



24



BIRTH


DATE

EXPIRATION

DATE

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

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 TWP. NJ 07930 SUSPENSION 8/29/1997

CHAMBERS, CAROL CHHA 9/25/1956 1022 STUYVESANT AVENUE IRVINGTON NJ 07111 SUSPENSION 1/20/2004

CHAMPION, MARY

MARGARET

RN/CHHA 9/26/1963 91 MOUNT AIRY AVENUE,

SOUTH

EGG HARBOR NJ 08234 SUSPENSION 6/20/2005 6/11/2013

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 ST. ENGLEWOOD NJ 07631 DISQUALIFICATION 6/1/1993

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.,

APT 221

EAST BRUNSWICK NJ 08816 DISQUALIFICATION 11/21/2016

CHIAPPETTA, THERESA 7/6/1974 8 STEINHARDT AVENUE OLD BRIDGE NJ 08857 DEBARMENT 9/15/2008

For verifications


State of New Jersey



25



BIRTH


DATE

EXPIRATION

DATE

CHIAPPETTA, THERESA 7/6/1974 8 STEINHARDT AVENUE OLD BRIDGE NJ 08857 DISQUALIFICATION 11/12/2009

CHILDREN'S DENTAL

CENTER

1992974406 3700 KENNEDY BLVD. UNION CITY NJ 07087 DEBARMENT 9/15/2017

CHILLEMI, SALVATORE 7/10/1962 29 BERKSHIRE DRIVE SEWELL NJ 08080 DISQUALIFICATION 6/10/2011

CHIRUMAMILLA, RAMABU RPH 212 E. PITTSBURGH AVENUE WILDWOOD CREST NJ 08260 DISQUALIFICATION 3/11/1985

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 RD. SOUTH SEAVILLE NJ 08246 DISQUALIFICATION 8/11/2007

CHRISTMAS, ARTHUR 6/7/1978 66 NORTH 11TH STREET NEWARK NJ 07107 DEBARMENT 6/16/2006

CHUDRY, RAZA 4/6/1959 RD #5 FEDERAL PRISON LEWISBURG PA 17837 SUSPENSION 9/19/2002

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 PL. 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

CICCONE, GREGORY 12/22/1976 5 WATERS EDGE DR. LITTLE EGG HARB 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

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

For verifications


State of New Jersey



26



BIRTH


DATE

EXPIRATION

DATE

CLARK, INDIA CHHA 8/24/1989 5 SECOND AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 7/14/2017

CLARK, JAMES 9/26/1955 380 MOUNTAIN RD. #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, MICHELLE CHHA 5/27/1971 75 NORTH WALNUT STREET,

APT. 6C

EAST ORANGE NJ 07017 DISQUALIFICATION 1/30/2017 PERMANENT

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

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,

INC.

626 N. 38TH STREET BELLEVILLE IL 62223 DISQUALIFICATION 6/4/1997

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 RD. 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

For verifications


State of New Jersey



27



BIRTH


DATE

EXPIRATION

DATE

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

COLLIER, KENYA CHHA 9/19/1980 708 THIRD AVENUEM APT. 13-

B

ASBURY PARK NJ 07712 DISQUALIFICATION 1/31/2017

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

M.

3/28/1973 437 STUYVESANT AVENUE IRVINGTON NJ 07111 SUSPENSION 11/7/2008

COMESANAS, MARIO MD 11/25/1955 1508922659 COLUMBIA TPK. FLORHAM PARK NJ 07932 DISQUALIFICATION 8/10/2007

COMPAS, JEAN CLAUDE MD 11/6/1948 1720178148 255 EASTERN PARKWAY, 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

CONNERS, LAURA LPN 6/9/1976 11 FENWAY RD. HAMILTON NJ 08620 SUSPENSION 3/20/2002

CONOVER, WILLIAM S. LPN 7/23/1965 225 RUTLAND AVENUE MT. HOLLY NJ 08060 SUSPENSION 5/20/2004

CONTEH, AMARA S. MD 8/10/1943 3 OLD TAPPAN RD. 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

PSYCHIATRIC GROUP

301 COOPER STREET CAMDEN NJ 08012 DISQUALIFICATION 5/2/1990

COPLIN, GEORGE J. MD 1/23/1908 528 EAST JERSEY ST ELIZABETH NJ 07206 DISQUALIFICATION 6/1/1993 DECEASED

CORNELY, MICHAEL P. DC 12/11/1962 1326199803 6650 BROWINING RD. MERCHANTVILLE NJ 08109 DISQUALIFICATION 12/1/1998

CORSON, KENNETH E. MD 5/12/1904 5 SOUTH MYRTLE ST VINELAND NJ 08360 DISQUALIFICATION

For verifications


State of New Jersey



28



BIRTH


DATE

EXPIRATION

DATE

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.

2

LONG BRANCH NJ 07740 SUSPENSION 3/21/2000

COSTINO JR., JOHN DO 7/22/1944 1811978414 404 SURF AVENUE WILDWOOD NJ 08260 DISQUALIFICATION 8/18/2011

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

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 FORT DIX FCI, BOX 38 FORT DIX NJ 08640 DISQUALIFICATION 10/18/2001

COWAN JR., JAMES MD 3/19/1944 1063527026 572 WEST SADDLE RIVER

ROAD

RIDGEWOOD NJ 07450 DISQUALIFICATION 9/20/2016 PERMANENT

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

ROAD

RIDGEWOOD NJ 07450 DISQUALIFICATION 12/21/2016 DECEASED

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 RD. PHILLIPSBURG NJ 08865 SUSPENSION 8/20/2006

CRAY, JASON E. COTTAGE

AIDE

7/8/1969 WARREN COUNTY JAIL BELVIDERE NJ 07823 DISQUALIFICATION 8/21/2000

For verifications


State of New Jersey



29



BIRTH


DATE

EXPIRATION

DATE

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 AKA

SULLIVAN, CYNTHIA

RPH 6/12/1966 PIN OAK COURT SHAMONG NJ 08088 SUSPENSION 4/20/2008 6/15/2017

CROCKER JR., KENNETH W. 12/11/1975 15 VIOLA AVENUE LEONARDO NJ 07737 DEBARMENT 7/17/2009 7/17/2014

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.

4401

JERSEY CITY NJ 07302 DISQUALIFICATION 4/16/2018 PERMANENT

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

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

For verifications


State of New Jersey



30



BIRTH


DATE

EXPIRATION

DATE

CUNNINGHAM, MICHAEL

D.

MD 11/10/1951 PO BOX 505 GLEN SPEY NY 12737 SUSPENSION 9/19/2002

CUPO, DAWN LPN 10/21/1961 129 ADELPHIA RD. FARMINGDALE NJ 07727 SUSPENSION 6/20/2001

CUPOLO, STACY J. DENTAL

HYGIENIS

T

1/5/1962 897 INVERNESS CT., APT. A LAKEWOOD NJ 08701 SUSPENSION 6/20/2005

CURETON, WILLIE T. 8/12/1969 61 CHELSEA AVENUE NEWARK NJ 07106 DISQUALIFICATION 5/27/2011

CURETON, WLLIE 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 RD. 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

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

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

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, 451

FULLERTON AVENUE

CAMBRIDGE

SPRINGS

PA 16403 DISQUALIFICATION 11/20/2015

DALY, LAUREN MD 3/7/1972 1952492233 SCI CAMBRIDGE SPRINGS, 451

FULLERTON AVENUE

CAMBRIDGE

SPRINGS


D'AMICO, DENNIS RPH 4/12/1951 91 OTTOWA RD SOUTH MARLBORO NJ 08817 DISQUALIFICATION 3/11/1985

For verifications


State of New Jersey



31



BIRTH


DATE

EXPIRATION

DATE

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 RD 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 W. LONG BRANCH NJ 07764 SUSPENSION 3/10/2000

DARA, PARVEZ MD 4/9/1951 1215952775 214 COMMONS WAY, BLDG B TOMS RIVER NJ 08755 DEBARMENT 10/12/2011

DARBY, MARK COUNSEL

OR

8/9/1968 SBI305830E, EJSP RAHWAY NJ 07065 DEBARMENT 1/1/2010

DARBY, MARK COUNSEL

OR

8/9/1968 SBI305830E, EJSP RAHWAY NJ 07065 DEBARMENT 11/18/2010

D'ASCOLI, BARTHOLOMEW MD 6/3/1949 PO BOX 1869 MONTAGUE NJ 07827 DEBARMENT 8/18/2000

DASS, SUMAN K. MD 10/13/1930 4 BALDWIN AVENUE JERSEY CITY NJ 07304 SUSPENSION 10/4/2000

DASS, SUMAN K. MD 10/13/1930 4 BALDWIN AVENUE JERSEY CITY NJ 07304 DEBARMENT 10/4/2000

DATCHER, ANTHONY 1/31/1984 SCI DALLAS, FOLLIES RD.,

DRAWER K

DALLAS PA 18612 DISQUALIFICATION 11/20/2015

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 STREEET, 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

For verifications


State of New Jersey



32



BIRTH


DATE

EXPIRATION

DATE

DAVIS, ANTOINETTE 6/21/1968 43 VERNON COURT SICKLERVILLE NJ 08081 DISQUALIFICATION 4/23/2007

DAVIS, CHARLES M. COUNSEL

OR

9/18/1950 1902045511 381 BALA AVENUE BALA CYNWYD PA 19004 SUSPENSION 3/31/2008

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

#1701

JACKSONVILLE FL 32225 DISQUALIFICATION 11/20/2015

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 ST 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 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,

MATILDA/MATHILDA

MD 9/23/1926 230 W. JERSEY ST. ELIZABETH NJ 07202 DISQUALIFICATION 6/13/1985

DAVIS, NICOLE RN 3/23/1978 544 ACKLEY ROAD NEWPORT NJ 08345 DISQUALIFICATION 6/4/2018

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

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

DE LA ROSA ACOSTA,

BIENVENIDA

CHHA 6/15/1969 355 OAK STREET, APT. 8 PASSAIC NJ 07055 DISQUALIFICATION 1/31/2017

For verifications


State of New Jersey



33



BIRTH


DATE

EXPIRATION

DATE

DEAN, RANDY MD 5/7/1956 1083924807 3991 NORTH WEST 99TH

AVENUE

CORAL SPRING FL 33065 DISQUALIFICATION 11/20/2015

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

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 CT

HOUSE


DEEMI, SAMUEL 8/19/1965 665 MARTIN LUTHER KING

BLVD.


DEFEO, DELORES A. CNM 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

DEIXLER, GLENN CHHA 9/14/1957 262 PRIVATEER ROAD MANAHAWKIN NJ 08050 DISQUALIFICATION 4/19/2018

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 RD. MONMOUTH

JUNCTION


DELANCEY, WAYNE K. PHARM

TECH

3/27/1986 1020 HIDEAWAY COURT VINELAND NJ 08361 DISQUALIFICATION 9/16/2011

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 RD. 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

DELOACH, LORRAINE CHHA 7/24/1964 9 DAVID STREET, APT. 3 SOUTH RIVER NJ 08882 DISQUALIFICATION 1/31/2017

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

For verifications


State of New Jersey



34



BIRTH


DATE

EXPIRATION

DATE

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

DERRICK, NAOMI K. RN 5/5/1975 6 ENGLISH IVY DRIVE SICKLERVILLE NJ 08081 DISQUALIFICATION 12/26/2016

DESAI, BAKUL MD 12/29/1952 1376654624 15 MOUNTAIN RIDGE DRIVE LIVINGSTON NJ 07039 SUSPENSION 3/8/2010

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

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, RTE 37 DANBURY CT 06811 DEBARMENT 5/20/2012

DEVERA, MONICA T. 5/4/1945 118 BEACON STREET DUMONT NJ 07628 SUSPENSION 8/20/2002

DEVLIN, MARYELLEN RN 1/21/1959 809 DEVON ROAD RIVERSIDE NJ 08075 DISQUALIFICATION 6/4/2018 PERMANENT

DEZENHALL, MERVIN RPH 11/27/1930 SUNSET RD AT SUMMIT TURN WILLINGBORO NJ 08046 DISQUALIFICATION 6/1/1993

For verifications


State of New Jersey



35



BIRTH


DATE

EXPIRATION

DATE

DI SPALTRO, FRANKLIN L. MD 5/28/1940 1740627082 MELROSE LANE GREEN VILLAGE NJ 07935 SUSPENSION 10/18/2007

DIAZ, PEDRO P. 1/18/1930 80 SKYTOP RD. 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 DR 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. 4/2/1967 DOGWOOD TRAIL RANDOLPH NJ 07869 SUSPENSION 11/20/2008

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 ST. 13D WESTVIEW NJ 08093 SUSPENSION 2/19/2004

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,

APT. 47C

CAMDEN NJ 08021 DISQUALIFICATION 2/8/2017

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 5/22/1984 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

DIRENZO, ALFRED M. DO 11/3/1934 167 GROVE STREET LODI NJ 07644 DISQUALIFICATION 2/21/1995

For verifications


State of New Jersey



36



BIRTH


DATE

EXPIRATION

DATE

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 BLVD EDISON NJ 08837 DISQUALIFICATION 4/30/2015

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

DOBROWOLSKI, DONALD DMD 6/17/1955 1184764664 45 BRICK BLVD. S-108 BRICK NJ 08723 DISQUALIFICATION 12/29/1995

DOLINER, PAUL MD 12/3/1927 401 US HIGHWAY 22 N. 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 MD 1/26/1958 53 3RD AVENUE TOMS RIVER NJ 08757 DISQUALIFICATION 7/9/2003 DECEASED

DONALDSON, DENISE MD 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

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

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

For verifications


State of New Jersey



37



BIRTH


DATE

EXPIRATION

DATE

DOUGHERTY-PRICE, ANITA

JO

CHHA 3/31/1954 212 WESTMONT AVENUE WESTMONT NJ 08108 DISQUALIFICATION 5/22/2017

DOWNTOWN DENTAL

CENTER

1 WEST BROADWAY PATERSON NJ DISQUALIFICATION 2/20/2001

DOYLE, JUDITH M. RN 11/15/1969 71 WILDFLOWER LANE MORRISTOWN NJ 07960 DEBARMENT 10/20/2004

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

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

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 RD. 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

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

For verifications


State of New Jersey



38



BIRTH


DATE

EXPIRATION

DATE

EASY DENTAL PC 1093093585 5616 GERMANTOWN AVENUE PHILADELPHIA PA 19114 DISQUALIFICATION 11/20/2015

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

EDMONDS, KIANNAH CHHA 8/21/1994 916 4TH AVENUE WALL TOWNSHIP NJ 07719 DEBARMENT 12/6/2017

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

EIDMAN, STEVEN DDS 10/12/1956 73 E. LINCOLN AVENUE ENGLEWOOD NJ 07631 SUSPENSION 1/19/2003

EJIOFOR, UDOKA RN/APN 3/23/1963 1295096584/

1982024790

47 KENMORE AVENUE NEWARK NJ 07106 DEBARMENT 4/26/2018

EKSTEROWICZ, DEBORAH LPN 6/6/1954 283 S. BLACKHORSE PIKE MOUNT EPHRIAM NJ 08059 SUSPENSION 7/18/2002

ELAMIR, MAGDY MD 4/17/1953 1710081336 14 HIGH MEADOW RD. 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

MAHGOUB

1/1/1961 160 ALABAMA AVENUE PATERSON NJ 07505 SUSPENSION 1/28/2001

ELBASHIR, IMAD

MAHGOUB

1/1/1961 PO BOX 7450 TRENTON NJ 08628 SUSPENSION 6/17/2004

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

For verifications


State of New Jersey



39



BIRTH


DATE

EXPIRATION

DATE

ELLIS, KENT R. MD 12/1/1952 1005 N. WASHINGTON

AVENUE

GREEN BROOK NJ 08812 DEBARMENT 6/15/2001

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 ST. BROWNS MILLS NJ 08015 SUSPENSION 5/20/2004

ENEMUO, JOHNNY 10/15/1966 215 JACOBY ST., 1ST FLOOR MAPLEWOOD NJ 07040 DISQUALIFICATION 5/1/1999

ENEMUO, KENNETH O. RPH 3/30/1962 236-242 S. ORANGE AVENUE NEWARK NJ 07103 DISQUALIFICATION 3/20/1999 10/26/2017

ENGRISSEI, PATRICIA LEISE 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

ERKOBONI, PATRICIA RN 6/25/1964 1850 W. MCGALLIARD

AVENUE

TRENTON NJ 08610 DISQUALIFICATION 5/14/2018

ERNST, DAVID J. DDS 7/7/1955 5 BRUNSWICK WOOD DRIVE E. BRUNSWICK NJ 08816 DISQUALIFICATION 3/31/1995

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

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

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 51 NEW YORK NY 10031 DEBARMENT 1/31/2008

ESTERMAN, SIDNEY N. DPM 5/20/1932 185 CENTRAL AVENUE, STE.

412

EAST ORANGE NJ 07019 DISQUALIFICATION 8/31/2001

For verifications


State of New Jersey



40



BIRTH


DATE

EXPIRATION

DATE

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

EVRA, JOANEL CHHA 5/6/1986 1551B ASBURY AVENUE ASBURY PARK NJ 07712 DISQUALIFICATION 8/29/2017

EZELL, PAUL MD 2/28/1956 1235130741 251 SAGAMORE RD. 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

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

FALOWO, YETUNDE 2/16/1972 301 MAPLE AVENUE, APT266 N. PLAINFIELD NJ 07060 DISQUALIFICATION 1/6/2006

FAMILY ENRICHMENT

INSTITUTE

415 KEIM BOULEVARD BURLINGTON NJ 08016 SUSPENSION 8/20/1999

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 BLVD. TOMS RIVER NJ 08753 DISQUALIFICATION 6/5/2017

FASWALA, MUNIR H. MD 3/20/1957 506 LAGOON BLVD. BRIGANTINE NJ 08203 DEBARMENT 9/15/2008

FASWALA, MUNIR H. MD 3/20/1957 506 LAGOON BLVD. 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

For verifications


State of New Jersey



41



BIRTH


DATE

EXPIRATION

DATE

FAULX, LORI RN 8/4/1966 4444 N 7TH AVENUE, APT.

417

PHOENIX AZ 85013 DISQUALIFICATION 11/20/2015

FAUSTINO, ALAN MD 4/18/1967 1669482568 110 WEST CHURCH STREET ABSECON NJ 08201 SUSPENSION 8/29/2016

FEE, CATHERINE ANN RPH 5/9/1965 7353 CLUBHOUSE CIRCLE EGG HARBOR CITY NJ 08215 SUSPENSION 10/19/2006

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

FELSENBERG, SANFORD 517 SO ORANGE AVENUE NEWARK NJ 07103 DISQUALIFICATION 6/1/1993

FERMIN, ESPERANZA CHHA 12/18/1981 229 MADISON AVENUE, APT.

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, 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

For verifications


State of New Jersey



42



BIRTH


DATE

EXPIRATION

DATE

FIGUEROA, JORGE MD 7/15/1958 1770542151 USP-LEWISBURG, PO BOX

1000

LEWISBURG PA 17837 DISQUALIFICATION 4/19/2018

FILIPPONE JR., DENNIS R. MD 11/18/1957 147 STANTON RD. FLEMINGTON NJ 08822 DEBARMENT 11/21/1998

FINDER, RICHARD DC 6/12/1956 810 ABBOTT BLVD. 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

TRANS.

2824 KENNEDY BLVD. #465 JERSEY CITY NJ 07306 DISQUALIFICATION 6/14/1994

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

FINKEL, MARINA 4/30/1963 EDNA MAHAN CORRECTIONAL CLINTON NJ 08809 DISQUALIFICATION 6/15/2014

FINLAY MEDICAL

LABORATORY

4912 BERGENLINE AVENUE WEST NEW YORK NJ 07093 DISQUALIFICATION 3/14/1998

FIRESPIRIT, INC. 6612 TERRA DOLCE AVENUE

NW

ALBUQUERQUE NM 87114 DISQUALIFICATION 6/23/2011

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

TECH

5/16/1996 115 SENECA BOULEVARD BARNEGAT NJ 08005 DISQUALIFICATION 11/21/2016

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 NY 10963 SUSPENSION 4/20/2005

FLEISCHMAN, EDWARD DO 10/3/1928 3804 CHURCH RD. MOUNT HOLLY NJ 08054 SUSPENSION 8/25/1998

For verifications


State of New Jersey



43



BIRTH


DATE

EXPIRATION

DATE

FLEMING, KEVIN M. MD 6/30/1954 1508816075 710 STATION AVENUE, 2ND

FLR

HADDON HEIGHTS NJ 08035 SUSPENSION 11/20/2010

FLEURANTIN, RUBEN J. MD 11/20/1951 SCOTLAND RD. 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. #1 PASSAIC NJ 07055 DISQUALIFICATION 3/6/2018

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 PHD 3/25/1947 1733 BLAKE BOTTOM RD. NW HUNTSVILLE AL 35806 DISQUALIFICATION 2/26/2010

FOGLER, SEAN MD 10/8/1968 1548322068 1900 HAMILTON STREET PHILADELPHIA PA 19130 DISQUALIFICATION 8/28/2017

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

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

For verifications


State of New Jersey



44



BIRTH


DATE

EXPIRATION

DATE

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

12D

SANIBEL FL 33957 DISQUALIFICATION 8/20/2015

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 OFFICE PARAMUS NJ 07652 DISQUALIFICATION 11/4/1991 4/5/2018

FRANCILLON. CARLINE LPN 7/23/1985 98 ASHLAND AVENUE, 2ND

FLOOR

WEST ORANGE NJ 07052 DEBARMENT 11/13/2017

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

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

FRANKLIN MEDICAL

ASSOCIATES

14 FRANKLIN STREET BELLEVILLE NJ DISQUALIFICATION 10/15/1999

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

7

VERONA NJ 07044 DISQUALIFICATION 1/10/2011 12/4/2014

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

For verifications


State of New Jersey



45



BIRTH


DATE

EXPIRATION

DATE

FREE, KEVIN R. MD 12/13/1955 14 PATTEN TERRACE CEDAR GROVE NJ 07009 DISQUALIFICATION 7/14/1998

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

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 RD PENNSAUKEN NJ 08109 SUSPENSION 6/19/2003

FRIMPONG, JOSEPH CHHA 3/2/1948 357-363 LINCOLN AVENUE,

APT. 3D

ORANGE NJ 07050 DISQUALIFICATION 1/31/2017

FRIMPONG, KOFI LPN/RN 7/23/1951 ESSEX RD. 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 RD, PO BOX 274 WHITEHOUSE NJ 08888 DISQUALIFICATION 4/18/1992

FROMER, CARL H. MD 4/25/1950 1000 CLOVER RD., APT. 7R STATEN ISLAND NY 10314 DISQUALIFICATION 6/20/2000

FROMM, JOSEPH MICHAEL 10/29/1947 28301 ATLANTIC AVENUE

#110 S

ATLANTIC CITY NJ 08401 DISQUALIFICATION 3/17/1991

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

FURLONG, KELLY AKA

COPPOLA, KELLY

PHARM

TECH

3/21/1985 52 CORNELL DRIVE HAZLET NJ 07730 DISQUALIFICATION 9/23/2016

GABER, ROBERT A. DDS 11/13/1947 100 VAIL RD. PARSIPPANY NJ 07054 DISQUALIFICATION 12/19/1988

GABRIEL, NWALA RPH 7/7/1960 34 SCHOOL STREET PISCATAWAY NJ 08854 DISQUALIFICATION 2/23/2010

For verifications


State of New Jersey



46



BIRTH


DATE

EXPIRATION

DATE

GADHOK, RAJINDER S. 8/9/1937 120 CIRCEL AVENUE, BOX 121 BERKELEY HEIGHTS NJ 07922 DISQUALIFICATION 8/12/1997

GAFFNEY, JOHN DO 4/7/1962 1710985387 9501 VENTNOR AVENUE MARGATE CITY NJ 08402 DISQUALIFICATION 7/24/2017

GAINER, JAHNIA PHARM

TECH

11/29/1992 176 AVON AVENUE. APT. 4A NEWARK NJ 07108 DEBARMENT 4/26/2016

GAINES, TONI 8/3/1974 4650 COLES MILL RD. R-3 WILLIAMSTOWN NJ 08094 DISQUALIFICATION 8/4/2012 8/3/2014

GAITHER, HERBERT MD 11/21/1936 1453 HILLCREST COURT, APT.

407

CAMP HILL PA 17011 DISQUALIFICATION 11/20/2015

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 B. RN 9/19/1950 132 TULIP LANE SUMMIT NJ 07901 SUSPENSION 9/20/2005

GALLAGHER, BRENDA JO RN/LPN 5/4/1955 14B WISHING WELL RD. 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 RD. MICKLETON NJ 08056 DISQUALIFICATION 8/20/2014

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

A1

VINELAND NJ 08361 DISQUALIFICATION 2/19/2009

GAMAO, EDDIE MD 6/2/1940 1639479397 375 NORTH DRIVE J9 NORTH PLAINFIELD NJ 07060 DISQUALIFICATION 3/14/2018

For verifications


State of New Jersey



47



BIRTH


DATE

EXPIRATION

DATE

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 2035 HAMBURG PIKE WAYNE NJ 07410 DISQUALIFICATION 8/20/1997

GARCEN, GINA AKA

CIALLELLA, GINA

DC 4/14/1962 57 GREEN STREET WOODBRIDGE NJ 07095 DISQUALIFICATION 3/24/2000

GARCIA, DIANE LCSW 12/3/1947 6612 TERRA DOLCE AVENUE

NW

ALBUQUERQUE NM 87114 DISQUALIFICATION 1/18/2012

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

TECH

3/10/1990 119 GLEN AVENUE LAKEWOOD NJ 08701 DISQUALIFICATION 9/23/2016

GARRITANO, RALPH E. MD 9/12/1924 281 GROVE ST 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

CLEMENTON

BLACKWOOD NJ 08012 DEBARMENT 9/22/2015

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 ST PHILLIPSBURG NJ 08865 DISQUALIFICATION 1/10/1988 DECEASED

GENSHEIMER, MAUREEN LPN 3/1/1957 1409 EDGEMERE RD. WALL NJ 07719 SUSPENSION 9/19/2002

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

GEORGIA LUNG

ASSOCIATES

1104989136 3820 MEDICAL PARK AVENUE AUSTELL GA 30106 DISQUALIFICATION 11/20/2015

For verifications


State of New Jersey



48



BIRTH


DATE

EXPIRATION

DATE

GERARDO, LETRICIA M. MD 6/4/1934 317 MT. PROSPECT AVENUE NEWARK NJ 07104 DISQUALIFICATION 5/30/1997

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,

MARIA

DC 9/14/1971 1487782504 FCI COLEMAN MEDIUM, PO

BOX 1032

COLEMAN FL 33521 DISQUALIFICATION 11/20/2015

GIALANELLA, CRAIG MD 10/28/1963 1467596502 4 OXFORD ROAD NORTH CALDWELL NJ 07006 DISQUALIFICATION 7/19/2017

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

SUEANNE

RPH 1/19/1951 9 KINGWOOD AVENUE FRENCHTOWN NJ 08825 DISQUALIFICATION 2/15/2001

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 CT., 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,

DEANNE

LPN 4/3/1985 46 BURT STREET BRIDGETON NJ 08302 DISQUALIFICATION 8/28/2017

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. 2H ASBURY PARK NJ 07712 SUSPENSION 4/20/2003

GILLER, LEONID 9/4/1949 4 WOODFERN STREET EDISON NJ 08820 DEBARMENT 8/27/1999

For verifications


State of New Jersey



49



BIRTH


DATE

EXPIRATION

DATE

GILLIARD, MICHELLE CHHA 4/18/1978 2929 HURLEY POND ROAD WALL NJ 07719 DEBARMENT 1/20/2017

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

STEWART

MD 10/23/1955 1306985882 FRANKLIN DRIVE ARDMORE OK 73401 SUSPENSION 9/18/2008

GILTMAN, JEROME RPH 4/18/1934 7320 VENTOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION 4/30/2007

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 STREET PHILADELPHIA PA 19130 DISQUALIFICATION 6/28/2017 PERMANENT

GLASS, JOEL MD 12/23/1942 1861537219 2027 SPRING GARDEN STREET PHILADELPHIA PA 19130 DISQUALIFICATION 10/27/2017 PERMANENT

GLASS, MICHAEL R. PSYCH 7/3/1933 1345 SLATERVILLE RD. 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

TECH

6/15/1993 6 HILLSIDE TERRACE SUSSEX NJ 07461 DISQUALIFICATION 2/1/2018

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 -

RRM #66231-050 100 29TH

STREET


GOLDBERG, RICHARD MD 2/6/1950 1629136320 95 DAVIS HILL ROAD WESTPORT CT 06883 DEBARMENT 7/1/2015

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

For verifications


State of New Jersey



50



BIRTH


DATE

EXPIRATION

DATE

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, SUITE

4

RIDGEWOOD NJ 07450 SUSPENSION 3/20/2003

GOMEZ, ALFREDO CHHA 12/23/1965 148 NORTH 10TH STREET,

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 RD. 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, PO

BOX 420

FAIRTON NJ 08320 DISQUALIFICATION 2/9/2017

GONZALEZ, LEAH CHHA 3/27/1993 5 TWIN RIVERS DRIVE EAST WINDSOR NJ 08520 DEBARMENT 1/16/2017

GONZOPH, BARBARA AKA

DUFFY, BARBARA

LPN 3/29/1964 208 WAYNE TERRACE COLLINGSWOOD NJ 08108 SUSPENSION 8/19/2004

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 RD. NORTH HALEDON NJ 07508 DEBARMENT 1/17/2014 4/11/2017

GOODWIN, BARBARA G. RN 2/23/1959 1201 NORTH CHARLOTTE ST. DICKSON TN 37055 SUSPENSION 12/19/2002

GORDON, BARBARA X-RAY

TECH

8/23/1963 133 MORTON AVENUE S. 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

For verifications


State of New Jersey



51



BIRTH


DATE

EXPIRATION

DATE

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 RD. FAYETTEVILLE NY 13066 DISQUALIFICATION 7/20/2015

GOROVITS, LILIA MD 4/20/1958 1427163427 1157 METTLER ROAD HUNTINGTON

VALLEY


GOTAY, ALEXANDER LCSW 8/26/1961 SSCF, PO BOX 150 DELMONT NJ 08314 DISQUALIFICATION 2/24/2008

GOULBOURNE, MARIANA CHHA 6/19/1964 430 S. 13TH STREET NEWARK NJ 07103 DISQUALIFICATION 3/6/2018

GRANGER, MAI AKA

GRIFFITHS, MAI

CHHA 9/21/1958 15 PEPPERMINT LANE WILLINGBORO NJ 08046 DISQUALIFICATION 9/29/1999

GRANT, NICOLE CHHA 11/28/1984 18 BUCKNELL DRIVE TOMS RIVER NJ 08757 DISQUALIFICATION 1/31/2017

GRANVILLE, PEDRO JULIO LAB

TECH.

1/30/1962 823 BROADWAY WEST LONG

BRANCH


GRASSER, JENNIFER AKA

KROWICKI, JENNIFER

RN 7/6/1963 232 CLUB DRIVE WALL NJ 07719 SUSPENSION 10/20/2002

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

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 RD. LIVINGSTON NJ 07039 DISQUALIFICATION 9/2/1992 DECEASED

For verifications


State of New Jersey



52



BIRTH


DATE

EXPIRATION

DATE

GREENBERG, ANTHONY MD 3/17/1960 1487641239 576 STATE ROUTE 94 COLUMBIA NJ 08732 DISQUALIFICATION 10/29/2016

GREENBERG, EDMUND RPH 11/15/1939 270 HIGHLAND RD. S. ORANGE NJ 07079 DISQUALIFICATION 2/7/2000

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 RD. 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 AVENUE BERWYN PA 19312 DISQUALIFICATION 11/20/2015

GRIETZER, JOY RN 1/4/1964 406 EAST FRANKLIN STREET WEST BERLIN NJ 08091 DEBARMENT 7/22/2017

GRIFFIN, CHARLES RPH 9/15/1985 1669757530 HAZELTON USP, PO BOX 2000 BRUCETON HILL WV 26525 DISQUALIFICATION 11/20/2015

GRIFFIN, REMY CHHA 4/14/1984 490 PARK AVENUE, APT. 3-B PATERSON NJ 07504 DISQUALIFICATION 5/2/2017

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,

APT. 5

WAYNESBORO PA 17268 DISQUALIFICATION 12/29/2015

GROSS, KENNETH M. DC 1/28/1971 1740488709 333 PROVINCIAL DRIVE MORGANVILLE NJ 7751 DISQUALIFICATION 6/20/2018

GROSSETT II, KENNETH W. RPH 6/22/1945 SOUTH DUPONT RD. CARNEYS POINT NJ 08069 SUSPENSION 3/20/2008

GRULLON, KADIA CHHA 1/5/1990 204 ACKERMAN AVENUE CLIFTON NJ 07011 DISQUALIFICATION 4/19/2018

GUENSCH, LISA M. RN 11/2/1966 85 MORNING GLORY RD. WARREN NJ 07059 DISQUALIFICATION 5/20/2009

For verifications


State of New Jersey



53



BIRTH


DATE

EXPIRATION

DATE

GUERRERO, RAUL 10/25/1968 110 JEROME AVENUE S. BOUND BROOK NJ 08880 SUSPENSION 1/20/2004

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 DR, 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

FAC

DELMONT NJ 08314 DISQUALIFICATION 11/21/1995

GUILIANO, GINA RN 12/16/1977 1 KINDERKAMACK RD. WOODCLIFF LAKE NJ 07677 SUSPENSION 12/18/2003

GULLA, FRANK T. MD 2/13/1939 113 RTE. 46 W. WILLOW SQ. WAYNE NJ 07470 DISQUALIFICATION 12/7/1999

GUPTA, NAVEEN RPH 4/11/1943 1700 OAK TREE RD. EDISON NJ 08820 DEBARMENT 3/4/1999

GUPTA, RASHMI J. COUNSEL

OR

6/22/1972 203 HASSE AVENUE PARAMUS NJ 07652 DEBARMENT 7/30/2012

GUPTA, RASHMI J. COUNSEL

OR

6/22/1972 10913 CORY LAKE DRIVE TAMPA FL 33647 DEBARMENT 7/3/2013

GURBAN, ELHAN 10/15/1962 14 FAHRNER STREET BERGENFIELD NJ 07621 DISQUALIFICATION 8/16/2016

GURBAN, ELHAN 10/15/1962 SOUTHERN STATE CF, 4295

RT. 47

DELMONT NJ 08314 DEBARMENT 12/16/2015

GUREVICH, NATALIA MD 11/24/1946 31-23 CRESCENT ST. APT 2C ASTORIA NY 11106 SUSPENSION 9/20/2005

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

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 RD. 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

For verifications


State of New Jersey



54



BIRTH


DATE

EXPIRATION

DATE

HAITMANEK, OTTILLIE M. LPN 9/5/1968 4162 BAYBERRY COURT MONMOUTH

JUNCTION


HALAS, JOHN 6/23/1945 144 WHITEHALL DRIVE VOORHEES NJ 08043 SUSPENSION 5/20/2002

HALL, AFRIKA AKA

JACKSON, AFRIKA

8/1/1970 BRIARWOOD DRIVE TOBYHANNA PA 18466 DISQUALIFICATION 10/2/2007 6/28/2018

HALL, ANNA M. RN 10/11/1937 44 LAKE TRAIL EAST WAYNE NJ 07470 SUSPENSION 10/18/2001

HALL, KIM 11/18/1965 5 UNAMI LANE SCOTCH PLAINS NJ 07076 DISQUALIFICATION 1/23/2009

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, KRISTINA 5/10/1978 7 OAK HILL DRIVE WAYNE NJ 07470 DISQUALIFICATION 11/16/2017

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 RD. 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

TECH

3/11/1985 50 WILLETT AVENUE SOUTH RIVER NJ 08882 DISQUALIFICATION 11/21/2016

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 RD KATY TX 77450 SUSPENSION 8/20/2002

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 BLVD EWING NJ 08638 DISQUALIFICATION 4/22/2006

HARRIS, PAUL MD 3/13/1965 GB-46 PO BOX 26010 BEAUMONT TX 77720 SUSPENSION 11/20/2006

For verifications


State of New Jersey



55



BIRTH


DATE

EXPIRATION

DATE

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 LIVERY PO BOX 930 NEW YORK NY 10013 DISQUALIFICATION 3/26/1994

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

TWP.


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

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 RD. BRICK NJ 08724 SUSPENSION 5/20/2004

HERNANDEZ, JENNIFER

OFELIA

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 RD. GETTYBURG PA 17325 DISQUALIFICATION 11/20/2015

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 RD. 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

For verifications


State of New Jersey



56



BIRTH


DATE

EXPIRATION

DATE

HESSEIN, AMGAD A. MD 10/2/1956 1578637260 BAYSIDE STATE PRISON, PO

BOX F-1

LEESBURG NJ 08327 DISQUALIFICATION 5/1/2017

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 AVENUE LIVINGSTON NJ 07039 DISQUALIFICATION 1/7/1983 DECEASED

HHCH HEALTH CARE 1639294812 ALDERSON FEDERAL PRISON

CAMP, CLAY GRAY ROAD, BOX

A

ALDERSON WV 24910 DISQUALIFICATION 5/24/2017

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 RD. NEPTUNE NJ 07753 SUSPENSION 10/20/2002

HIGGINS, MARTIN 3/12/1943 706 BLOOMFIELD AVENUE NUTLEY NJ 07110 SUSPENSION 7/20/2005

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

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, 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 RD. 513 PITTSTOWN NJ 08867 SUSPENSION 6/14/2000

For verifications


State of New Jersey



57



BIRTH


DATE

EXPIRATION

DATE

HOLCA, LIVIU MD 1/25/1958 1053348417 1137 BEACON AVENUE MANAHAWKIN NJ 08050 SUSPENSION 11/25/2014

HOLLOWAY, JAZMINE CHHA 2/12/1995 95 CUMMINGS AVENUE IRVINGTON NJ 07111 DISQUALIFICATION 1/23/2018

HOLMES, THERESA CHHA 2/20/1986 1290 N. 27TH STREET CAMDEN NJ 08105 DISQUALIFICATION 2/12/2018 8/20/2018

HOMAN, WALTER W. CHHA 11/24/1959 FORECASTLE AVENUE BEACHWOOD NJ 08722 SUSPENSION 8/21/2008

HOME CARE SOLUTIONS 216 NORTH AVENUE E, STE. 2 CRANFORD NJ 07016 SUSPENSION 1/24/2014

HONG, JOSEPH S. MD 1/1/1964 1346258001 34 FOREST DRIVE WATCHUNG NJ 07069 DISQUALIFICATION 9/29/2016

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 AVENUE PARLIN NJ 08859 DISQUALIFICATION 3/27/2018

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 RD. EGG HARBOR NJ 08234 SUSPENSION 10/27/2009

HOUTAN, FARAH PTA 7/23/1957 269 STEELMANVILLE RD. 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

TOWNSHIP

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 PSYCH 8/29/1920 925 CLIFTON AVENUE CLIFTON NJ 07013 DISQUALIFICATION 12/1/1998

HSIA, VINCENT RPH 10/5/1959 1710209291 SCHUYLKILL FCI 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

For verifications


State of New Jersey



58



BIRTH


DATE

EXPIRATION

DATE

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

HUNTER-CORREA, LOUISA DDS 6/17/1965 372 FOREST AVENUE PARAMUS NJ 07652 SUSPENSION 10/22/2010

HUSSAIN, IFTIKHAR 6/12/1966 9 VAN COURTLAND AVENUE STATEN ISLAND NY 10301 DISQUALIFICATION 1/29/2003

HUSSAIN, ZAHID MD 12/3/1974 1992733232 301 ROUTE 9 NORTH FREEHOLD NJ 07728 SUSPENSION 9/30/2011 7/22/2016

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 RD, BOX 190 MIDDLETOWN NJ 07748 DEBARMENT 1/29/2001

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, OLUWAFEMI

AKA CHARLES IGBERASE

RN 4/17/1962 14909 DOWNEY COURT,

SUITE 200

BOWIE MD 20721 DISQUALIFICATION 5/20/2018

IGBINADUWA, NEWTON RPH 6/20/1955 116-35 139TH STREET JAMAICA NY 11436 SUSPENSION 5/19/2005

IGHAMA-AMEGOR, IBILOLA MD 3/12/1962 1639251804 59 MAPLE AVENUE VAUXHALL NJ 07088 DISQUALIFICATION 8/16/2017

IGNACCOLO, EMANUELE 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 RD. WAYNE NJ 07470 DISQUALIFICATION 10/27/2013

ILLINGWORTH, DONNA LPN 8/20/1959 1505 CLAIRE RD. FORKED RIVER NJ 08731 SUSPENSION 5/19/2005

For verifications


State of New Jersey



59



BIRTH


DATE

EXPIRATION

DATE

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

FLOOR


INNES JR., GEORGE

MICHAEL

MD 1/16/1961 1736 EAST GENESEE ST. FAYETTEVILLE NY 13066 SUSPENSION 7/20/2005

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 ST. 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

CLEMENTON ROAD

BLACKWOOD NJ 08012 DISQUALIFICATION 12/29/2017

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 DR. CHERRY HILL NJ 08034 DISQUALIFICATION 4/6/1995

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, 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

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

For verifications


State of New Jersey



60



BIRTH


DATE

EXPIRATION

DATE

JACKSON, ZEKIA CHHA 3/7/1988 232 JUSTIN WAY WILLIAMSTOWN NJ 08094 DISQUALIFICATION 10/19/2017

JACKSON-GILLARD,

CRYSTALYNN

CHHA 6/16/1990 3 BORDEN AVENUE, APT. 8 ASBURY PARK NJ 07712 DISQUALIFICATION 4/24/2018

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

AVENUE

HAMILTON NJ 08610 DISQUALIFICATION 2/12/2018

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

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

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

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

For verifications


State of New Jersey



61



BIRTH


DATE

EXPIRATION

DATE

JASINSKI, DARIUS DPM 3/17/1975 1013995182 1225 MCBRIDE AVENUE WOODLAND PARK NJ 07424 DEBARMENT 12/29/2016

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

JASZCZULT, JOAN E. DO 6/29/1961 50 NEWARK AVENUE, APT 309 BELLEVILLE NJ 07109 DEBARMENT 2/3/2006

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 RD. BRIDGETON NJ 08302 DISQUALIFICATION 8/20/2013

JAYARAM, AJIT MD 12/20/1947 1295773869 215 SOUTH BURLINGTON RD. BRIDGETON NJ 08302 DISQUALIFICATION 4/4/2014

JEAN-BAPTISTE,

DEMESVAR A.

MD 1/3/1973 1831227719 775 MOUNTAIN BLVD, STE. 1 WATCHUNG NJ 07069 SUSPENSION 9/19/2011 DECEASED

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

644

FLAGSTOWN NJ 08821 DISQUALIFICATION 11/27/2016

JEFFERSON, MICHAEL K. DMD 8/12/1954 1811956238 408 PADDOCK COURT SEWELL NJ 08080 DISQUALIFICATION 8/16/2016 5/12/2017

JEFFRIES, MARC 9/5/1964 2 MILLER LANE WHITEHOUSE STAT NJ 08889 DISQUALIFICATION 3/13/2014

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, JOSE COUNSEL

OR

6/27/1955 EXTENSION VILLA RITA SAN SEBASTIAN PR 00685 SUSPENSION 12/8/2003 12/8/2011

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

For verifications


State of New Jersey



62



BIRTH


DATE

EXPIRATION

DATE

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, 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 DR LAKEWOOD NJ 08701 SUSPENSION 9/14/2005

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

#MC4261

MFT 10/4/1960 1780999847 SCI CAMP HILL, PO BOX 200 CAMP HILL PA 17001 DISQUALIFICATION 9/29/2017

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

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

TECH

8/3/1992 734 STERLING STREET PLAINFIELD NJ 07062 DISQUALIFICATION 7/22/2017

JONES, MICHELLE N. CHHA 11/26/1983 446 PROSPECT STREET-B16 LAKEWOOD NJ 08701 SUSPENSION 9/30/2005

For verifications


State of New Jersey



63



BIRTH


DATE

EXPIRATION

DATE

JONES, ROSALIN CHHA 11/30/1970 159 PFEIFFER STREET CAMDEN NJ 08105 DISQUALIFICATION 2/20/2017

JONES-HATTOH, CHATIQUA CHHA 7/8/1984 3 ROANOKE AVENUE, APT. 2C NEWARK NJ 07108 DISQUALIFICATION 1/23/2018

JONES-PRICE, ANTIONETTE 10/17/1965 PO BOX 1006 WENDELL NC 27591 DISQUALIFICATION 6/1/2000

JONES-PRICE, ANTOINETTE 10/17/1965 120 S. 20TH STREET IRVINGTON NJ 07111 SUSPENSION 3/16/1998

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 ST., SUITE 111 PASADENA CA 91101 SUSPENSION 4/22/1997

JOSHI, JAYENDRA B. 9/13/1959 95-05 37TH AVENUE, APT. 1-A JACKSON HEIGHTS NY 11373 DISQUALIFICATION 6/4/1997

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

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

W.

DPM 6/18/1928 438 BROADWAY LONG BRANCH NJ 07746 DISQUALIFICATION 6/1/1993

JYAMFI, CHARLES RPH 9/24/1953 71 OLD SHORT HILLS ROAD WEST ORANGE NJ 07052 SUSPENSION 3/22/2006

KADISHA, INC. 667 MOUNT PROSPECT

STREET

NEWARK NJ 07104 SUSPENSION 5/14/1998

KAHONU, ANNE N. 12/19/1985 315 MILL ST. S. PLAINFIELD NJ 07080 DEBARMENT 1/19/2013

For verifications


State of New Jersey



64



BIRTH


DATE

EXPIRATION

DATE

KALFUS, DENIS H. DPM 12/9/1945 1015 EAST GLEN AVENUE WASHINGTON TWP NJ 07606 SUSPENSION 6/19/2003

KALINOWSKI, KAROL RN 5/11/1984 31 COVINGTON LANE VOORHEES NJ 08043 DISQUALIFICATION 3/28/2017

KALLEN, HERBERT 10/26/1919 274 RIVER RD. 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

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

106


KANIA, RAMESHCHAN MD 12/14/1952 1235158403 310 CENTRAL AVENUE, SUITE

106

EAST ORANGE NJ 07018 SUSPENSION 2/22/2012

KANKAM, MARTIN 13 G READING RD. 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 RD. SECAUCUS NJ 07094 DISQUALIFICATION 8/26/1988

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, FRANCES R. RPH 2/8/1950 615 SUMMIT RD. 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,

ALEXANDER

8/7/1961 90 WEST HILL RD. WOODCLIFF LAKE NJ 07677 DEBARMENT 9/20/2007

KAUFMAN, SHOSHANA

AKA STOCKELBERG,

SHOSHANA

LCSW 11/10/1977 349 JESTER COURT OLD BRIDGE NJ 08857 DISQUALIFICATION 7/15/2009 11/7/2014

KAUL, RICHARD MD 11/5/1964 1902838790 292 ATLANTIC STREET HACKENSACK NJ 07601 DEBARMENT 8/1/2014

For verifications


State of New Jersey



65



BIRTH


DATE

EXPIRATION

DATE

KAVROS, STEVEN J. DPM 7/22/1954 1316912801 12 HERITAGE COURT CHERRY HILL NJ 08034 DISQUALIFICATION 6/1/1993

KAWAM JABAKJI,

MOHAMED

MD 1/27/1959 1760541312 6 BARKER PLACE WAYNE NJ 07470 DEBARMENT 5/16/2016

KAWAM JABAKJI,

MOHAMED

MD 1/27/1959 1760541312 6 BARKER PLACE WAYNE NJ 07470 DISQUALIFICATION 7/20/2017

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 RD. 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. B13 CAMDEN NJ 08104 DISQUALIFICATION 2/8/2017

KELLUM, EARLENE CHHA 5/25/1978 279 S. BLACKHORSE PIKE MOUNT EPHRAIM NJ 08059 DISQUALIFICATION 3/5/2018

KELLY, MICHELLE 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

KESHISHIAN, PAUL DO 6/25/1951 1437207610 625 COBH RD. 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 FORT DIX FCI, 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 AVENUE NEWARK NJ 07114 SUSPENSION 12/16/1998

For verifications


State of New Jersey



66



BIRTH


DATE

EXPIRATION

DATE

KHAN, AZAM HAYAT 1/18/1962 687 FRELINGHUYSEN AVENUE NEWARK NJ 07114 DISQUALIFICATION 10/21/1999

KHAN, AZAM HAYAT 1/18/1962 107 CHARLESTON AVENUE STATEN ISLAND NY 10309 DISQUALIFICATION 7/7/2008

KHAN, MUNIR 8/15/1953 238 GRAND ST., APT. 1 JERSEY CITY NJ 07302 DEBARMENT 8/20/2009

KHAN, SALEEM M. 9/19/1967 336 2ND ST., 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 AVE., STE.

L1

VERONA NJ 07044 SUSPENSION 2/22/2012

KHANNA, YASH K. MD 12/28/1941 1093805012 310 CENTRAL AVENUE EAST ORANGE NJ 07018 DISQUALIFICATION 11/30/2014

KHARKOVER, ALEKSANDR PT 2/13/1962 1861594889 FCI FORT DIX, PO BOX 2000 FORT DIX 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

KILLEN, DAWN LPN 8/13/1961 804 COTSWOLD RD. 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, SABRINA 6/4/1965 341 OSBOURNE TERRACE, 2C NEWARK NJ 07106 DISQUALIFICATION 2/23/2009

KIMMEL, STEVEN DO 420 DELAWARE ST. MINNEAPOLIS MN 55455 DEBARMENT 4/1/2002

KINDER, EDWARD P. 3/24/1965 5180 LA TERRA AVENUE PAHRUMP NV 89061 DEBARMENT 7/17/2009 7/17/2014

KING, DEBORAH AKA

BENTON, DEBORAH

LPN 5/10/1958 9 RADFORD PLACE WILLINGBORO NJ 08046 DISQUALIFICATION 10/18/2001

For verifications


State of New Jersey



67



BIRTH


DATE

EXPIRATION

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 TWP. NJ 08008 SUSPENSION 4/20/2003

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

AUDIOLO

GIST 11/15/1950 1609995307 1 CLARIDGE DRIVE, APT. 508 VERONA NJ 07044 DISQUALIFICATION 2/11/2016

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

BOULEVARD


KMET, NAZARIY 5/9/1978 2284 SANDTRAP RD. JAMISON PA 18929 DISQUALIFICATION 11/20/2015

KMET, ROSTISLAV 2/2/1989 13021 BLAKESLEE DRIVE, APT.

A


KOBYLECKYJ, CHRYSTYNA RN 6/22/1965 35 WOODCOCK MOUNTAIN

ROAD

WASHINGTONVILLE NY 10992 DISQUALIFICATION 9/29/2015

KOCH, MARK DO 9/9/1959 1528102647 336 BARNES RD. MONROEVILLE AL 36460 DISQUALIFICATION 11/20/2015

For verifications


State of New Jersey



68



BIRTH


DATE

EXPIRATION

DATE

KOGAN, VADIM RN 9/2/1966 56 NORMANDY DRIVE PRINCETON JUNCT NJ 08550 SUSPENSION 12/18/2003

KOLLMER, W. LANCE MD 6/3/1948 101 OLD SHORT HILLS RD. WEST ORANGE NJ 07052 DEBARMENT 7/18/2001 DECEASED

KONTOS, DEMETRIUS D. MD 3/27/1935 463 TENAFLY RD. 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 ELKTON FCI, BOX 10 LISBON OH 44432 DISQUALIFICATION 4/19/2007

KOSLOV, GLEB M. DC 9/30/1958 1366584583 388 RAMAPO VALLEY RD. OAKLAND NJ 07436 DISQUALIFICATION 12/1/1998

KOTHALANKA,

SITARAMAKRISHNA

MD 6/14/1950 1184644080 562 SW ROMORA BAY PORT LUCIE FL 34986 DISQUALIFICATION 10/25/2016

KOTTURI, SHIVA MD 2/15/1950 1013168251 512 KEARNY AVENUE, SUITE B KEARNY NJ 07032 DISQUALIFICATION 6/17/2018 PERMANENT

KOUSOULIDES, LOUISE RN 4/13/1961 34 TOPANEMUS LN, APT. 14 FREEHOLD NJ 07728 DISQUALIFICATION 4/20/2009

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

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 ST 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 BLVD EAST, APT. 6J NORTH BERGEN NJ 07047 SUSPENSION 12/20/2004

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

KROHN, IVAN T. MD 6/2/1943 1467429258 33 NORTHWOOD DRIVE VINELAND NJ 08360 DEBARMENT 5/20/2012

For verifications


State of New Jersey



69



BIRTH


DATE

EXPIRATION

DATE

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

KRUTOYARSKY, IRINA 2/23/1954 ALDERSON FEDERAL PRISON

CAMP, #65107, CLAY GRAY

ROAD, BOX A

ALDERSON WV 24910 DISQUALIFICATION 12/12/2016

KUBACKI, JOSEPH MD 4/7/1949 1306834213 PO BOX 3949 PENSACOLA FL 32516 DEBARMENT 5/20/2013

KUBLIN, ANNE MD 6/21/1960 182 WHALEPOND RD. EATONTOWN NJ 07724 SUSPENSION 3/19/2004

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 RD. MONMOUTH

JUNCT.


KUMAR, SAROJ 1/22/1954 184 OLD BEEKMAN RD. MONMOUTH

JUNCT.


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

KURLANDER-ZAKARIA,

TRACI

RN 3/20/1962 20 ROCK ROYAL RD. TRENTON NJ 08620 DISQUALIFICATION 2/26/2010

KURTZ, JOEL P. DMD 10/1/1944 1285874743 9 WESTGATE RD. 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, PO

BOX 244

GRATERFORD PA 19426 DISQUALIFICATION 11/20/2015

KUYINU, MICHAEL MD 9/28/1947 1235173568 34 VANDERVEER DRIVE BELLE MEAD NJ 08502 DEBARMENT 12/16/2015

For verifications


State of New Jersey



70



BIRTH


DATE

EXPIRATION

DATE

KYMER, RHIANNON

(ROOSMA)

RN 4/1/1980 8 SPENCER LANE WARREN NJ 07059 DISQUALIFICATION 3/27/2018

LABORDE, JAMES DC 6/3/1955 1578541504 329 SOUTH HIGHLAND STREET DUBOIS PA 15801 DISQUALIFICATION 11/20/2015

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 RD. 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

LAGUERRE, JEAN EDWARD RPH 9/19/1968 1 62ND STREET, APT. 4C W. NEW YORK NJ 07093 DEBARMENT 8/16/2007

LAGUERRE, JEAN EDWARD RPH 9/19/1968 1 62ND STREET, APT. 4C WEST NEW YORK NJ 07093 DISQUALIFICATION 2/29/2008

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 KAY MD 2/19/1966 1184656050 1625 ANDERSON AVENUE FORT LEE NJ 07024 DEBARMENT 3/6/2014

LAM, MICHAEL CHUNG KAY MD 2/19/1966 1184656050 2 8TH STREET ENGLEWOOD CLIFF NJ 07632 DISQUALIFICATION 11/14/2014

LAMBRIOLA, VINCENT P. DDS 5/1/1956 143 LITTLE FALLS CEDAR GROVE NJ 07009 DISQUALIFICATION 2/20/2001

For verifications


State of New Jersey



71



BIRTH


DATE

EXPIRATION

DATE

LAMP, REBECCA RN/CNP 2/14/1963 1568511236 139 DERWOOD DR. 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

LAMPROU JR., EMANUEL MD 9/9/1953 1033104526 509 N. BROAD ST. WOODBURY NJ 08096 DEBARMENT 12/18/2012 12/18/2015

LANCE-LANNIGAN, JUDITH 8/27/1955 12 PROSPECT HILL FLEMINGTON NJ 08822 DISQUALIFICATION 7/23/2010

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 RD. TEANECK NJ 07666 SUSPENSION 10/20/2002

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 RD. 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-B SAYREVILLE NJ 08872 DISQUALIFICATION 2/8/2017

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

LATAWIEC, ANDREA RN 3/7/1964 1681 RARITAN RD. CLARK NJ 07066 SUSPENSION 5/20/2002

LATCHMAN, BHANWATIE PHARM

TECH

4/9/1977 76 WATSON AVENUE EAST ORANGE NJ 07052 DEBARMENT 5/16/2016

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

LAVELLE, BARBARA RN/APN 8/28/1958 550 LINCOLN AVENUE RIDGEFIELD NJ 07657 SUSPENSION 12/18/2003

For verifications


State of New Jersey



72



BIRTH


DATE

EXPIRATION

DATE

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 ST MATAWAN NJ 07747 DISQUALIFICATION 6/1/1993

LEATHERDALE, LAURA CHHA 8/27/1982 4 MEETINGHOUSE RD. WRIGHTSTOWN NJ 08562 SUSPENSION 9/19/2003

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, 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. 6-

H

NEW YORK NY 10011 DEBARMENT 11/21/2016

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

LEKWAUWA, CHUKWUEKE RN 1/1/1967 1643 PARK STREET RAHWAY NJ 07065 DEBARMENT 8/28/2017

LEON, JACK 6/9/1965 2991 E. CHESTNUT AVE., 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

LEONARD, JUDITH RPH 12/10/1958 70 LAUREL DRIVE LITTLE SILVER NJ 07739 SUSPENSION 2/20/2005

For verifications


State of New Jersey



73



BIRTH


DATE

EXPIRATION

DATE

LEONARD, TROY COUNSEL

OR

12/26/1983 1851691448 999 COLONIAL ROAD FRANKLIN LAKES NJ 07417 DISQUALIFICATION 11/22/2016 PERMANENT

LEPKO, ERVIN MD 2/11/1928 18 JANE DRIVE ENGLEWOOD NJ 07632 SUSPENSION 5/20/2002

LERNER, ELIZABETH 8/8/1967 GLEN RAY RD., BOX A ALDERSON WV 24910 SUSPENSION 7/20/2008

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

14500

LEXINGTON KY 40512 DISQUALIFICATION 1/9/2016

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 RD. COLTS NECK NJ 07722 SUSPENSION 6/22/1999

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 ST. SUITE 235 FORT LEE NJ 07024 SUSPENSION 12/20/2001

LEWANDOWSKI, KENNETH DO 9/16/1963 1114070398 100 ATLANTIC AVENUE CAMDEN NJ 08101 DEBARMENT 8/28/2014

LEWANDOWSKI, KENNETH DO 9/16/1963 1114070398 24 PEACH BLOSSOM LANE MIDDLETOWN NJ 07748 DISQUALIFICATION 11/20/2015

LEWANDOWSKI, KENNETH DO 9/16/1963 1114070398 24 PEACH BLOSSOM LANE MIDDLETOWN NJ 07748 DEBARMENT 6/30/2016

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 AVENUE FRANKLINVILLE NJ 08322 DISQUALIFICATION 1/29/2018

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 8/17/1945 1528169539 6 RANNEY ROAD LONG VALLEY NJ 07853 DISQUALIFICATION 6/30/2018 PERMANENT

For verifications


State of New Jersey



74



BIRTH


DATE

EXPIRATION

DATE

LI, STAN MD 2/10/1954 1386631794 16 SECRETARIO WAY HAMILTON NJ 8690 DISQUALIFICATION 8/20/2015 PERMANENT

LI, STAN MD 2/10/1954 1386631794 16 SECRETARIO WAY HAMILTON NJ 8690 DISQUALIFICATION 11/18/2015 PERMANENT

LIBRIZZI, MICHELLE H. LPN 3/25/1961 5 BELLIS CT. 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 SERVICES

OF NORTHWESTERN

PENNSYLVANIA DBA GREAT

LAKES HOME HEALTHCARE

SERVICES

1972641496 2127 NORTH 6TH STREET PHILADELPHIA PA 19122 DISQUALIFICATION 12/29/2015

LIFE SUPPORT

CORPORATION

1659699049 CI MOSHANNON VALLEY, 555

GEO DRIVE

PHILLIPSBURG PA 16866 DISQUALIFICATION 12/29/2015

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


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 RT. 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

For verifications


State of New Jersey



75



BIRTH


DATE

EXPIRATION

DATE

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


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

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, PATRICIA 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 1427150846 24 WOODLAND RD. 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

ANTONIO

8/23/1954 8385 SW 43RD STREET MIAMI FL 33155 DISQUALIFICATION 5/2/2003

LOPRESTI, JACQUELINE A. DO 12/30/1960 1043348220 568 RIDGE RD. FAIR HAVEN NJ 07704 SUSPENSION 12/20/2011

LOPRESTI, JACQUELINE A. DO 12/30/1960 1043348220 FPC ALDERSON ALDERSON WV 24910 DISQUALIFICATION 3/20/2014

For verifications


State of New Jersey



76



BIRTH


DATE

EXPIRATION

DATE

LOTTERMAN, RANDEE RN 7/10/1985 6 JUNIATA STREET WEST MILFORD NJ 07480 DISQUALIFICATION 6/15/2017

LOUIS-BAPTISTE, GUERLINE CHHA 5/2/1979 51 LINCOLN STREET EAST ORANGE NJ 07017 DISQUALIFICATION 10/20/2017

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

LOWREY, RODNEY 2/13/1945 88 3RD AVENUE ATLANTIC

HIGHLANDS

NJ 07716 DISQUALIFICATION

LUCA, BONNIE J. 9/15/1962 1016 WASHINGTON GARDENS WASHINGTON NJ 07882 DEBARMENT 6/10/2007

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

LUDWIKOWSKI, MICHAEL RPH 2/18/1972 113 DIXONTOWN ROAD MEDFORD NJ 08055 DISQUALIFICATION 4/13/2018

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

LYONS, DANA LPN 4/29/1963 245 4TH AVENUE ROEBLING NJ 08554 SUSPENSION 2/20/2002

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

AND LIVERY

269 SHEFFIELD STREET MOUNTAINSIDE NJ 07092 DEBARMENT 10/31/2002

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

For verifications


State of New Jersey



77



BIRTH


DATE

EXPIRATION

DATE

MADDOX, PEARL V. CHHA 9/8/1968 KINSLEY RD. PEMBERTON NJ 08068 DISQUALIFICATION 9/25/2007

MAHAJAN, SHYAM S. MD 3/18/1945 1144496449 7624-A BRISLIN RD, R.D.#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

MAHGOUB, ADAM 1/1/1961 1995 JFK BLVD., #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 ST. BROOKLYN NY 11223 SUSPENSION 3/18/2004

MAIGUE, LLEWELYN RN 11/30/1960 6 CRYSTAL AVENUE W. ORANGE NJ 07052 SUSPENSION 4/19/2001

MAIN PHARMACY, LLC 1861705873 80 SOUTH MAIN ROAD, SUITE

112


MAIORANO, JOHN RPH 2/13/1951 1659492940 345 UNION HILL RD. ENGLISHTOWN NJ 07726 DISQUALIFICATION 7/11/2000

MAIORANO, JOHN RPH 2/13/1951 1659192940 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

MALADY, SUSAN AKA

MAWHINNEY-BRIGNOLA,

SUSAN

RN 3/31/1949 PO BOX 468 BLAIRSTOWN NJ 07825 SUSPENSION 6/20/2001

MALAMUD, YAFIM 2/4/1942 177 SARGEANT AVENUE CLIFTON NJ 07013 DEBARMENT 8/8/2003

MALDONADO, CHEYENNE PHARM

TECH

9/22/1991 3 DUKE DRIVE TOMS RIVER NJ 08757 DEBARMENT 1/5/2017

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, MOHAMMAD S. 5/15/1960 146 OLD COURTHOUSE RD. MANHASSETT NY 11400 SUSPENSION 9/22/2000

MALIK, MOHAMMAD S. 5/15/1960 146 OLD COURTHOUSE RD. MANHASSETT NY 11040 SUSPENSION 10/20/2002

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 6/15/1964 284 REDMOND STREET NEW BRUNSWICK NJ 08873 SUSPENSION 5/14/2007

For verifications


State of New Jersey



78



BIRTH


DATE

EXPIRATION

DATE

MANCINI, ANGELO D. RPH 8/1/1950 SKEET & DIXONTOWN RD. MEDFORD NJ 08055 DISQUALIFICATION 7/1/1985

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 MT. HOLLY NJ 08060 DISQUALIFICATION 4/12/1993

MANION, WILLIAM MD 8/12/1952 1134120801 33 MEADOW DRIVE WOODSTOWN NJ 08098 DISQUALIFICATION 3/8/2018

MANKOFF, BERNARD GREEN GROVE RD. NEPTUNE NJ 07753 DISQUALIFICATION

MANNAVA, VENKATA

SRINIVAS

RPH 10/18/1969 1356478895 3300 EAST WEST HIGHWAY HYATTSVILLE MD 20782 DISQUALIFICATION 6/30/2016

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

MANSOUR, ALI MD 3/17/1968 1346225885 225 DEMOTT LANE SOMERSET NJ 08873 DEBARMENT 12/20/2014

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 RD., APT 22 C VINELAND NJ 08360 DISQUALIFICATION 6/1/1993

MANZONI, JANET M. DC 4/27/1955 1851497168 52 TENNET RD. 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

MARCELL, JOSEPH A. 305 MAIN ST RIDGEFIELD PARK NJ 07660 DISQUALIFICATION

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

MARKOSOVA, GRETA CHHA 1/3/1961 2301 WESTMINSTER

BOULEVARD

PARLIN NJ 08859 DISQUALIFICATION 1/31/2017

MARON, ANDREW DDS 6/12/1961 1215035134 326 BROAD STREET RED BANK NJ 07011 DISQUALIFICATION 10/21/2015

MARONPOT, BARBARA DDS 12/20/1953 1821203696 281 MENDHAM ROAD BERNARDSVILLE NJ 07924 DEBARMENT 3/17/2015

For verifications


State of New Jersey



79



BIRTH


DATE

EXPIRATION

DATE

MARQUEZ, MANUEL S. MD 6/5/1925 112 DOWNING COURT MT. LAUREL NJ 08054 DISQUALIFICATION 12/5/1997

MARQUEZ, OLGA COUNSEL

OR

2827 LINCOLN AVENUE CAMDEN NJ 08105 SUSPENSION 4/29/2003

MARRAZZO-TALLIA,

CHRISTAL

RPH 1/3/1955 406 HARDING RD. FAIRHAVEN NJ 07704 SUSPENSION 10/19/2006

MARSON-FRANCIS, JAVON CHHA 9/16/1993 7810 CORBETT ROAD PENNSAUKEN NJ 08109 DISQUALIFICATION 4/18/2017

MARTIN, ANDRE E. COUNSEL

OR

12/6/1972 127 N. DERBY AVENUE VENTNOR NJ 08406 DEBARMENT 5/24/1999

MARTIN, BENNIE M. COUNSEL

OR

12/19/1964 476 CLIFTON AVENUE CLIFTON NJ 07011 SUSPENSION 5/15/2003

MARTIN, ELLIOTT DPM 9/19/1936 5 HOLLIS RD. E. BRUNSWICK NJ 08816 DISQUALIFICATION 4/22/1991

MARTIN, MARGARET LPN 1/15/1959 207 HEGGEN AVENUE EGG HARBOR TWP. NJ 08234 DISQUALIFICATION 9/8/2017 PERMANENT

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. 3A JERSEY CITY NJ 07306 DISQUALIFICATION 2/20/2017

MARTINEZ, ELIEZER COUNSEL

OR

11/25/1947 215 SOUTH BURLINGTON RD. BRIDGETON NJ 08302 SUSPENSION 2/20/2006

MARTINEZ, RENATO F. MD 9/1/1948 199 BROAD ST., SUITE 1-A 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, ALEKSANDR DO 8/19/1963 1700931185 1084 BRIAR WAY FORT LEE NJ 07024 DISQUALIFICATION 11/20/2017 5/30/2018

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

For verifications


State of New Jersey



80



BIRTH


DATE

EXPIRATION

DATE

MARURI, NAGESWARA

REDDY RPH 3/20/1952 1083932495 8 REDWOOD AVENUE WEST ORANGE NJ 07052 DISQUALIFICATION 2/11/2016

MASCOLO, JOSEPHINE RN 6/4/1949 1814 KENNEDY BLVD. UNION CITY NJ 07087 DEBARMENT 4/7/2004

MASI, JAMES COUNSEL

OR

10/4/1947 1518046226 631 OCEAN AVENUE, APT.304 BRADLEY BEACH NJ 07720 DEBARMENT 2/20/2013

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. DDS 2/1/1966 360 GETTY AVENUE PATERSON NJ 07503 SUSPENSION 10/19/2000

MASSARO, DONNA M. THERAPIS

T

11/24/1959 205 RIVA DRIVE, APT. 24 HACKETTSTOWN NJ 07840 SUSPENSION 11/20/2008

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,

ANTHANASIOS

RPH 1/29/1973 1861769481 11 EQUINOX LANE FREEHOLD NJ 07728 DISQUALIFICATION 10/15/2009

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 DRIVE OLNEY MD 20832 DISQUALIFICATION 4/4/2018

MATRISS, JOSEPH P. DDS 7/3/1923 1700013554 337 HENRY STREET HASBROUCK

HEIGHTS


For verifications


State of New Jersey



81



BIRTH


DATE

EXPIRATION

DATE

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 PL. TOTOWA NJ 07512 SUSPENSION 6/20/2005

MAXVITAT, KATHLEEN E. PHARM

TECH

5/8/1986 200 W. MERCHANTS STREET AUDUBON NJ 08106 SUSPENSION 4/20/2011

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

MAZZACCOS PHARMACY

INC.

427 PROSPECT STREET LONG BRANCH NJ DISQUALIFICATION 7/27/1983

MCAFEE, JORDAN CHHA 7/24/1987 13 FAIRWAY COURT MARLTON NJ 08053 DISQUALIFICATION 7/20/2017

MCCABE, VALERIE A. LPN 1/21/1964 830 CHESTNUT STREET KEARNY NJ 07032 SUSPENSION 9/20/2004

MCCALL, ELDORA CHHA 1/7/1965 OLD CRANBURY RD. CRANBURY NJ 08512 SUSPENSION 9/20/2007

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

For verifications


State of New Jersey



82



BIRTH


DATE

EXPIRATION

DATE

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 THERAPIS

T

7/7/1954 2220 MEADOW LANE,

APT.D26

SECAUCUS NJ 07094 DISQUALIFICATION 2/20/2001

MCDONALD, RHONDA RN 8/20/1970 962 GROVE STREET IRVINGTON NJ 07111 SUSPENSION 1/18/2007

MCDONALD-HASWELL,

EVERSLEY

6/10/1955 52 ELM STREET MONTCLAIR NJ 07042 SUSPENSION 4/18/2002

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

LINDSAY

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

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 ST TRENTON NJ 08611 DISQUALIFICATION 10/16/1986

MCGINTY, JAMIE RN 5/9/1978 251 DEVON ROAD TOWNSHIP OF

WASHINGTON


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 RD. KENDALL PARK NJ 08824 SUSPENSION 10/20/2005

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 RD. EDMOND OK 73013 DISQUALIFICATION 5/15/2000

For verifications


State of New Jersey



83



BIRTH


DATE

EXPIRATION

DATE

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 RD. MANALAPAN NJ 07726 SUSPENSION 8/20/2008

MCLEAN, EDWARD 506 MONTICELLO COURT MARLTON NJ 08053 SUSPENSION 7/18/2002

MCLEISH, FREDERICK RPH 7/11/1962 1447461505 5 WINDSOR DRIVE EGG HARBOR TWP. NJ 08234 DISQUALIFICATION 7/19/2017 PERMANENT

MCMAHON, THOMAS MD 11/2/1944 1952309742 121 WARWICK ROAD HADDONFIELD NJ 08033 DEBARMENT 2/15/2016 PERMANENT

MCMURTRY-BURRELL,

DIANE

RPH 10/6/1965 1609015015 MDC BROOKLYN BROOKLYN NY 11232 DISQUALIFICATION 5/20/2015

MCMURTRY-BURRELL,

DIANE

RPH 10/6/1965 1609015015 MDC BROOKLYN, PO BOX

329002


MCPHERSON, KIMBERLY CHHA 5/14/1987 110 THOMAS AVENUE LAWNSIDE NJ 08045 DISQUALIFICATION 2/8/2017

MCPHERSON, M. LEEANNE RPH 12/27/1971 269 HAMPTON STREET BRIDGETON NJ 08302 SUSPENSION 3/7/2008

MCQUEEEN, 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 BLVD. RICHLAND NJ 08350 DISQUALIFICATION 2/23/2006

MEDICAL CLINICAL

LABORATORIES

373 LIVINGSTON AVENUE NEW BRUNSWICK NJ 08901 DISQUALIFICATION 7/29/1999

MEDIPATH EXPRESS 666 PLAINSBORO ROAD PLAINSBORO NJ 08536 DISQUALIFICATION 1/14/2005

MEDISCOPE DIAGNOSTIC

LAB

1250 PARK AVENUE PLAINFIELD NJ 07060 SUSPENSION 11/16/1998

MEDVEDIK, YELENA 10/15/1972 2 HICKORY HILLS COURT HOLMDEL NJ 07733 DISQUALIFICATION 10/3/2013

MEISHER, VLAD A. PSYCH 9/23/1939 HILLSIDE TERR. FAIR LAWN NJ 07410 DISQUALIFICATION 8/10/2007

MEISHER, VLAD A. PSYCH 9/23/1939 15-07-PLAZA RD., APT. A FAIRLAWN NJ 07410 DISQUALIFICATION 8/1/2009

MELENDEZ, JUANITA COUNSEL

OR

6/16/1938 NORTH 35TH STREET CAMDEN NJ 08105 SUSPENSION 4/29/2003

For verifications


State of New Jersey



84



BIRTH


DATE

EXPIRATION

DATE

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 RD. 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

MELTZER, SCOTT M. DMD 1/4/1964 1366561425 70 WELLESLEY WAY FREEHOLD NJ 07728 DEBARMENT 5/3/2013

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,

SUITE 106

TAMPA FL 33606 DISQUALIFICATION 12/29/2015

MENDEZ, EDELFONSO 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

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 RD. WAYSIDE NJ 07712 DISQUALIFICATION 5/27/2009

MERVIL, DARLENE 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/

1255309175

2 RICHMONDE COURT COLTS NECK NJ 07722 DEBARMENT 5/28/2015

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

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

For verifications


State of New Jersey



85



BIRTH


DATE

EXPIRATION

DATE

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

1000

LEWISBURG PA 17837 DISQUALIFICATION 2/9/2017

MILAROLA CORPORATION 57 BROADWAY NEWARK NJ 07014 DISQUALIFICATION

MILLER, DEBBIE L. DO 6/6/1949 1750561866 94 EAST WATER ST 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

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 401 IRVINGTON NJ 07111 SUSPENSION 2/25/1998

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

For verifications


State of New Jersey



86



BIRTH


DATE

EXPIRATION

DATE

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

MISHRA, ARUNA MD 8/10/1938 63 WEST BROADWAY SALEM NJ 08079 DISQUALIFICATION 2/4/1997

MISHRA, ARUNA MD 8/10/1938 317B AUBURN RD. 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 RD. 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

BROOK


MOHAMED, ASHLI CHHA 11/29/1990 104 FOUNTAIN AVENUE TRENTON NJ 08618 DISQUALIFICATION 1/31/2017

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 GRISTMILL LANE UPPER SADDLE

RIVER

NJ 07458 DISQUALIFICATION 9/20/2012 5/17/2018

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.

618

NEW YORK NY 10017 DISQUALIFICATION 6/28/2017

MONFORTO, CHRISTINE RN 7/6/1984 2620 HAMILTON DRIVE VOORHEES NJ 8043 DISQUALIFICATION 12/29/2015

MONICA, JULIANNE H. DC 4/12/1957 1235372608 509 ESSEX AVENUE SPRING LAKE NJ 07762 SUSPENSION 2/20/2002

MONSUL, ROBERT W. MD 6/1/1931 301 NORTH MAIN STREET MANVILLE NJ 08835 DISQUALIFICATION 5/10/1990

MONTES, NANCY CHHA 5/21/1966 17-20 WELL DRIVE FAIR LAWN NJ 07410 DISQUALIFICATION 8/1/2017

For verifications


State of New Jersey



87



BIRTH


DATE

EXPIRATION

DATE

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 RD. 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, JANE A. RN 2/27/1962 235 KINGS RD. 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 ST., APT. 19 ORANGE NJ 07050 SUSPENSION 10/20/2002

MOORE, LYNDA A. LPN 1/13/1968 10719 JUREL CT. W. APT. B LAKEVILLE MN 55044 SUSPENSION 1/19/2005

MOORJANI, KAMAL RPH 7/3/1970 217 VAN BUREN STREET LYNDHURST NJ 07071 DISQUALIFICATION 6/1/2010 8/26/2016

MOORMANN, BARBARA

ANN

CHHA 11/3/1947 2467 BREATHSTONE DRIVE POWELL OH 46065 DISQUALIFICATION 2/20/2017

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 2319 CRYSTAL MILE COURT TOMS RIVER NJ 08755 SUSPENSION 1/11/2016

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 CHHA 1/21/1965 121 PROSPECT VILLAGE, APT.

A


For verifications


State of New Jersey



88



BIRTH


DATE

EXPIRATION

DATE

MORELAND, CHARLOTTE CHHA 1/21/1965 121 PROPECT VILLAGE, APT. A TRENTON NJ 08618 SUSPENSION 9/20/2008

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 BLVD. TOMS RIVER NJ 08753 SUSPENSION 6/19/2003

MORENO, BARTOLO COUNSEL

OR

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 MT. 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 BLVD. TOMS RIVER NJ 08755 SUSPENSION 4/8/1999

MORRIS, CHRISTINE CHHA 12/3/1984 323 KAIGHN AVENUE CAMDEN NJ 08103 DISQUALIFICATION 5/16/2018

MORRISON, JAMES C. MD 2/13/1927 RADIO RD AT EAST BOAT TUCKERTON NJ 07087 DISQUALIFICATION 6/1/1993

MORTON, MARION RPH 3/3/1966 2321 SPRUILL AVENUE, APT.

917

NORTH

CHARLESTON

SC 29405 DEBARMENT 2/6/2012

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 RD. 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 RD. WEST MIDDLESEX PA 16159 DISQUALIFICATION 11/20/2015

For verifications


State of New Jersey



89



BIRTH


DATE

EXPIRATION

DATE

MOULDER, DARIA PHARM

TECH

1/16/1962 2715 BAYSHORE RD. VILLAS NJ 08251 DISQUALIFICATION 4/20/2010

MOUNT LAUREL CENTER

FOR REHAB AND

HEALTHCARE

1851669287 3718 CHURCH ROAD MOUNT LAUREL NJ 08054 DISQUALIFICATION 7/16/2017

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 3/4/1964 284 BROADWAY NEWARK NJ 07104 DISQUALIFICATION 11/8/2004

MUHAMMAD,

DIAMONNIQUE

CHHA 3/10/1992 354 7TH AVENUE WEST NEWARK NJ 07107 DISQUALIFICATION 7/14/2017

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

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 RD. LIVINGSTON NJ 07039 DEBARMENT 11/7/2011

MUNZEL, GREGORY

THOMAS

3/5/1976 140 WAPPOO CREEK DRIVE CHARLESTON SC 29412 DEBARMENT 4/22/2012

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 RD. CINNAMINSON NJ 08077 SUSPENSION 5/25/1999

For verifications


State of New Jersey



90



BIRTH


DATE

EXPIRATION

DATE

MURRY JR., TOMMIE 11/20/1958 2697 RAVEN RD. CINNAMINSON NJ 08077 DEBARMENT 1/5/2001

MURRY JR., TOMMIE 11/20/1958 2697 RAVEN RD. 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 AVE. VENTNOR CITY NJ 00840 DISQUALIFICATION 10/25/2016

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 RD. TRENTON NJ 08638 SUSPENSION 6/17/2004

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

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. 2 CRANFORD NJ 07016 SUSPENSION 1/24/2014

NATHAN, MICHAEL MD 11/3/1949 1578593422 1 PROSPECT LANE OKATIE SC 29909 DEBARMENT 8/1/2017

NATIONAL SPINE MEDICAL

CENTER

2103 GOLDEN POND DRIVE KINGWOOD TX 77345 SUSPENSION 4/20/2005

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 RD. YARDLEY PA 19067 SUSPENSION 6/7/2000 1/5/2018

NAYLOR, KIM M. PHARM

TECH

9/15/1958 1504 TAMIAMI RD. FORKED RIVER NJ 08731 DEBARMENT 9/19/2011

NAZARIO, JULISSA CHHA 6/6/1992 210 ROSEVILLE AVENUE, APT.

C1


For verifications


State of New Jersey



91



BIRTH


DATE

EXPIRATION

DATE

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 RD., SUITE F SPARTA NJ 07871 DISQUALIFICATION 5/20/2015

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 RD., APT. 101 MONROE

TOWNSHIP


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.

11307

PHILADELPHIA PA 19131 DISQUALIFICATION 4/17/2017 PERMANENT

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. RN 3/10/1974 312 BOULEVARD MOUNTAIN LAKES NJ 07046 SUSPENSION 1/21/2015

NICOLL, SCOTT R. 9/20/1980 120 BUNKER HILL RD. 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

NII, ROBERT PA 12/25/1965 1124254107 34 MILL BROOK ROAD PISCATAWAY NJ 08854 DISQUALIFICATION 9/21/2016 PERMANENT

For verifications


State of New Jersey



92



BIRTH


DATE

EXPIRATION

DATE

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

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

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

NORTH END FAMILY

MEDICAL CARE, INC.

1013079888 644 MT. PROSPECT AVENUE NEWARK NJ 07104 DISQUALIFICATION 7/20/2018

NORTHGATE COMMUNITY

PHARMACY

156 COUNTRY FARM ROAD MARLTON NJ 08053 DISQUALIFICATION 3/6/2006

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 &

MADISON

LAURENCE HARBOR NJ 08879 DISQUALIFICATION 4/30/1995

NUSSBAUM, ABRAHAM MD 7/28/1950 1578598082 91 MONTGOMERY STREET RHINEBECK NY 12572 SUSPENSION 1/15/2001 11/12/2013

NWANKWO, FESTUS RPH 7/27/1959 154 BLOOMFIELD AVENUE NEWARK NJ 07104 DISQUALIFICATION 11/18/1998

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'CALLAGHAN, TERESE RN 12/12/1958 5122 ORCHARD WAY PENNSAUKEN NJ 08109 SUSPENSION 10/20/2002

For verifications


State of New Jersey



93



BIRTH


DATE

EXPIRATION

DATE

OCANSEY, DONNA RN 2/1/1962 7 WISINA COURT MEDFORD NJ 08055 DEBARMENT 4/22/2012

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

ODUNZEH, UCHE 10/28/1981 3565 LAUREL FORTE MEADE

RD., APT. 41

LAUREL MD 20724 DISQUALIFICATION 11/20/2015

OGANDO, ERNESTINA CHHA 7/27/1985 943 SHERIDAN AVENUE ELIZABETH NJ 07208 DEBARMENT 4/18/2017 6/28/2018

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 THER 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

PHARMACY

1619148632 639 STOKES ROAD, SUITE 101 MEDFORD NJ 08055 DISQUALIFICATION 4/13/2018

OLIVEIRA JR., MARIO OD 4/8/1963 170 EAST KINNEY STREET NEWARK NJ 07105 DEBARMENT 4/28/2005

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

For verifications


State of New Jersey



94



BIRTH


DATE

EXPIRATION

DATE

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-2MN JERSEY CITY NJ 07306 DISQUALIFICATION 4/10/1997

O'NEILL - RYAN, LISA ANNE COUNSEL

OR

8/20/1961 415 LYNDALE STREET PHILLIPSBURG NJ 08865 DISQUALIFICATION 8/17/2008

O'NEILL - RYAN, LISA ANNE COUNSEL

OR

8/20/1961 415 LYNDALE STREET PHILLIPSBURG NJ 08865 SUSPENSION 5/9/2008

ONYEKAHA, EBERE RPH 11/15/1958 13 HIGHLAND AVENUE MAPLEWOOD NJ 07040 DISQUALIFICATION 12/1/1998

ONYENSO, CHIKE MD 9/18/1958 1578605812 552 MAIN STREET CHATHAM NJ 07928 SUSPENSION 2/15/2012

ONYENSO, CHIKE MD 9/18/1958 1578605812 18 EDINBURGH DRIVE RANDOLPH NJ 07869 DISQUALIFICATION 3/19/2015

OQUENDO, BASHIRAH CHHA 11/6/1986 87 MANNING AVENUE PLAINFIELD NJ 07060 DISQUALIFICATION 2/8/2017

ORANGE COMMUNITY MRI 345 HENRY STREET ORANGE NJ 07055 SUSPENSION 3/16/2012

O'REILLY, RAYMOND B 2/20/1949 188 ALEXANDRIA DR 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

JUNCTION


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,

APT. #70

BRIDGETON NJ 08302 DISQUALIFICATION 10/19/2017

For verifications


State of New Jersey



95



BIRTH


DATE

EXPIRATION

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, APT.

170M

EDISON NJ 08837 DISQUALIFICATION 8/24/2017

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 230 WEST PARKWAY POMPTON PLAINS NJ 07444 DISQUALIFICATION 2/11/2016

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

OTI, CHUCK B. 9/1/1973 676 PARK AVENUE, BLDG. 14B EAST ORANGE NJ 07017 DISQUALIFICATION 1/31/2000

OTISMED CORPORATION 1600 HARBOR BAY PKWY.,

SUITE 200

ALAMEDA CA 94502 DISQUALIFICATION 4/27/2015

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 RD. WASHINGTON

CROSSING

PA 18977 SUSPENSION 5/19/2005

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 SUPPLY,

INC.

1700016045 53 FRONTAGE ROAD, SUITE

100

HAMPTON NJ 08827 DISQUALIFICATION 12/8/2016

OXMAN, REED S. MD 3/8/1959 1649575473 226 W. RITTENHOUSE

SQUARE

PHILADELPHIA PA 19103 SUSPENSION 3/16/2012

OYENUSI, ADEBOWALE RPH 4/4/1956 90 WASHINGTON STREET EAST ORANGE NJ 07017 DEBARMENT 10/14/2000

For verifications


State of New Jersey



96



BIRTH


DATE

EXPIRATION

DATE

OZERY, TZIPORA AKA

MONICA MOORE

2/1/1969 27 FIRETOWER ROAD BUDD LAKE NJ 07828 DEBARMENT 9/15/2017

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

PACHECO, MICHAEL PHARM

TECH

9/2/1975 84 LAFAYETTE AVENUE PASSAIC NJ 07055 DEBARMENT 7/18/2003

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

PADVA-GERMAN, ANNA DDS 8/21/1962 1043382039 446 DUNLIN PLAZA, 446H SECAUCUS NJ 07094 DEBARMENT 10/15/2014

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.

2


PAKETT, NEIL DMD 7/18/1950 1184934663 777 WEST GERMANTOWN

PIKE, APT. 530

PLYMOUTH

MEETING


PALMER, THOMAS #14570-

003

RN 5/31/1975 1912200932 FPC PENSACOLA, PO BOX

3949

PENSACOLA FL 32516 DISQUALIFICATION 9/29/2017

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 RD. TOMS RIVER NJ 08753 DISQUALIFICATION 8/11/2007

PANICHELLA, ANTHONY G. COUNSEL

OR

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 DR NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 6/1/1993

For verifications


State of New Jersey



97



BIRTH


DATE

EXPIRATION

DATE

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 #69361-054 USP CANAAN, PO

BOX 300

WAYMART PA 18472 DISQUALIFICATION 11/20/2015

PAPPALARDO, PETER S. MD 6/27/1937 4 SOUTH AIRMONT RD SUFFERN NY 10901 DISQUALIFICATION 6/1/1993

PARADISO, NINO RPH 8/20/1943 57 POPLAR DRIVE MORRIS PLAINS NJ 07950 DISQUALIFICATION 9/9/2016

PARASHOS, LINDA RN 4/7/1963 514 9TH AVENUE LINDENWOLD NJ 08021 SUSPENSION 5/20/2001

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 AVENUE PHILADELPHIA PA 19119 DISQUALIFICATION 11/20/2015

PARIDA, SAROJ K. MD 10/21/1959 1013975549 USP LEWIS-PO BOX 1000 LEWISBURG PA 17837 DISQUALIFICATION 8/20/2013

PARIKH, BIPIN J. MD 8/4/1945 1962555193 224 LAFAYETTE STREET WILLISTON PARK NY 11596 SUSPENSION 11/20/2010

PARIKH, BIPIN J. MD 8/4/1945 1962555193 224 SOUTH LAFAYETTE

STREET

WILLISTON PARK NY 11596 SUSPENSION 7/9/2008

PARIKH, MANUPRASAD RPH 6/23/1941 209 STOKES FARM RD. FRANKLIN LAKES NJ 07417 SUSPENSION 7/20/2004 9/5/2017

PARK MEDICAL

LABORATORY

298 CLAIRMONT AVENUE MONTCLAIR NJ 07042 DISQUALIFICATION 8/20/1976

PARKOFF, MICHAEL A. DMD 9/3/1948 68 MAPLEWOOD BLVD SUFFERIN NY 10901 DISQUALIFICATION 8/7/1984

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 BLVD. 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 RD. WARREN NJ 07059 SUSPENSION 4/2/2012

PATEL, CHIRAG J. 9/22/1975 16 SNEIDER RD. WARREN NJ 07059 DISQUALIFICATION 4/20/2015

For verifications


State of New Jersey



98



BIRTH


DATE

EXPIRATION

DATE

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, MAHESH I. MD 10/26/1949 1942202841 3 PINE VALLEY WAY FLORHAM NJ 07932 DISQUALIFICATION 1/26/2015

PATEL, MEHMOOD M. MD 5/25/1945 1225074859 201 MIDDLETON RD. 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

C.

MD 8/24/1960 1306073200 8 NOTTINGHAM ROAD EDISON NJ 08820 DEBARMENT 11/21/2016

PATEL, PRAVIN, K. MD 5/17/1957 904 #35 IVY RIDGE RD SYRACUSE NY 13210 SUSPENSION 12/19/2002

PATEL, RAMBEN

DAHYABHAI

LPN 7/31/1953 505 WEST MINISTER BLVD. PARLIN NJ 08859 SUSPENSION 8/20/2000

PATEL, RAMESH SHANKER

BHAI

RN 8/15/1959 PO BOX 5564 OLD BRIDGE NJ 08857 SUSPENSION 6/20/2001

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 RD. ARDSLEY NY 10502 DEBARMENT 4/26/2016

PATEL, SANJAY I. RPH 6/4/1965 1316335961 63 HEATHERDELL RD. 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.

141

AVENEL NJ 07001 SUSPENSION 9/20/2004

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 RD. 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

For verifications


State of New Jersey



99



BIRTH


DATE

EXPIRATION

DATE

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

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 RD. LEWISTOWN PA 17044 DISQUALIFICATION 11/20/2015

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.

M1

MILLBURN NJ 07041 DISQUALIFICATION 12/1/1998

PEMBERTON, COLIN MD 5/6/1975 1891935557 500 ORANGE STREET NEWARK NJ 07107 DISQUALIFICATION 8/28/2017 4/26/2018

PENA, CARMEN F. DDS 8/29/1961 1871750166 800 76TH ST., 2ND FLOOR NORTH BERGEN NJ 07047 SUSPENSION 9/20/2000 9/15/2015

PENALES, AMANDO D. 7/30/1973 BAYSIDE PRISON, PO BOX F-1 LEESBURG NJ 08327 DISQUALIFICATION 5/9/2014

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 RD. DENVILLE NJ 07834 DEBARMENT 3/6/2014 3/2/2018

PENFIELD, JOHN DO 9/18/1967 1528078839 308 MURRAY HILL RD. 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

PEOPLE CHOICE HOME

CARE

1851416069 430 MORRIS AVENUE ELIZABETH NJ 07208 DISQUALIFICATION 5/24/2017

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 RD. YARMOUTH PORT MA 02675 DEBARMENT 1/3/2000 9/12/2017

PERRIN, DOUGLAS M. CHHA 4/18/1968 1801 LAURAL RD. LINDENWOLD NJ 08021 SUSPENSION 5/20/2002

PERRY, ELSWETTA CHHA 9/20/1955 291 NORTH PARK STREET, 1ST

FLOOR


For verifications


State of New Jersey



100



BIRTH


DATE

EXPIRATION

DATE

PESCIOTTA, BARBARA ANN 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

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 BLVD. 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.

2E

ORANGE NJ 07050 DISQUALIFICATION 3/12/2018

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 RD. HOWELL NJ 07731 SUSPENSION 5/20/2004

PIACENTILE, JOSEPH MD 4/3/1956 1265607410 578 BIG OAK RD. 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/

CHHA

9/3/1975 14 3RD STREET, FLOOR 1 NEWARK NJ 07107 DISQUALIFICATION 3/3/2017

For verifications


State of New Jersey



101



BIRTH


DATE

EXPIRATION

DATE

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 RD. 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

PLOTNIK, PYOTR MD 2/15/1944 1407019813 276 COLERIDGE STREET BROOKLYN NY 11235 DEBARMENT 5/23/2000

PLOTTS, LISA (FROSCH) RN 4/15/1976 111 BEECHWOOD AVENUE OAKLYN NJ 08107 SUSPENSION 10/18/2001

PLUCINSKI, PATRICIA LPN 8/11/1964 201 HAEGELE PLACE MOUNT ROYAL NJ 08061 SUSPENSION 12/20/2009

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

POGGIOLI, STEPHAN 5/11/1963 431 ACADEMY TERRACE LINDEN NJ 07036 SUSPENSION 6/18/2004

POH-EIKOM, VICKI 9/8/1953 619A BILLINGS AVE. PAULSBORO NJ 08062 DEBARMENT 12/29/1999

POH-EIKOM, VICKI 9/8/1953 619A BILLINGS AVE. PAULSBORO NJ 08062 DEBARMENT 1/11/2000

POINTE O'WOODS

PHARMACY

999 US HIGHWAY ROUTE 9 HOWELL NJ 07731 DISQUALIFICATION 7/11/2000

POLANSKY, IRVING RPH 2/5/1926 260 MAIN ST KEANSBURG NJ 07734 DISQUALIFICATION 7/9/1985

For verifications


State of New Jersey



102



BIRTH


DATE

EXPIRATION

DATE

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. 5 DEQUESNE PA 15110 DISQUALIFICATION 11/20/2015

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

POPKU, BISMARK CHHA 6/14/1968 2468 ANGLER ROAD COLUMBUS OH 43224 DISQUALIFICATION 4/6/2018

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., INC 1265 PATERSON PLANK ROAD SECAUCUS NJ 07094

DISQUALIFICATION

12/1/1998

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 2810 HIGH ST. 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

#206

OLD GREENWICH CT 06870 DISQUALIFICATION 8/1/2009

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

For verifications


State of New Jersey



103



BIRTH


DATE

EXPIRATION

DATE

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

PROVOST, LAURIE LPN 2/26/1960 10 BALTIMORE BLVD SEA GIRT NJ 08750 SUSPENSION 1/24/2014

PRZADOWSKA-KOKINDA,

ELIZABETH M.

RN 6/13/1978 1106 PARKSIDE AVENUE TRENTON NJ 08618 SUSPENSION 4/20/2005

PUCCI, BRIAN M. RPH 4/6/1958 14 RAND RD. 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

PULVIRENTI, FRANCESCA

M.

CHHA 4/21/1979 212 8TH STREET SURF CITY NJ 08008 SUSPENSION 9/29/2005

PURNESS, TIFFANY CHHA 8/11/1990 105 BLACKWOOD-

CLEMONTON ROAD #704

LINDENWOLD NJ 08021 DISQUALIFICATION 4/26/2018

QAYYUM, ABDUL RPH 12/2/1949 960 COUNTRY CLUB DRIVE TEANECK NJ 07666 SUSPENSION 4/27/2000

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 COUNSEL

OR

3/27/1980 106 SPRING VALLEY AVENUE,

#1

HACKENSACK NJ 07601 DISQUALIFICATION 12/20/2012

QUINN, JOHN, C. RN 1/19/1959 437 HARRISTOWN RD. 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 RD. JAMESBURG NJ 08831 SUSPENSION 1/20/2004

RABAH, MOHAMMAD DMD 11/30/1978 1669684114 55 ENCLOSURE STREET NUTLEY NJ 07030 DEBARMENT 3/3/2017

RADOWITZ, MARK A. DC 9/2/1959 76 CHICHESTER RD. MONROE

TOWNSHIP


For verifications


State of New Jersey



104



BIRTH


DATE

EXPIRATION

DATE

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,

NANDAVAR

MD 5/1/1952 1235219809 741 ROUTE 18 S. EAST BRUNSWICK NJ 08816 DEBARMENT 4/18/2014

RAMANADHAM, ARUNA R. 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. A ROSELLE NJ 07203 DEBARMENT 1/9/2018

RAMOS, JEANETTE CHHA 8/24/1989 234 WILMONT AVENUE CAMDEN NJ 08105 DISQUALIFICATION 5/2/2017

RAMOS, REYNALDO 12/22/1968 52 ABINGTON CT. MAYS LANDING NJ 08330 DEBARMENT 8/12/2013

RAMOS, ROLANDO 5/13/1977 85 SHERMAN AVENUE TEANECK NJ 07666 DISQUALIFICATION 2/20/2004

RAMPERSAD,

LAKSHMINARINE

8/20/1953 11 APPLETREE LANE LANDING NJ 07850 SUSPENSION 12/20/2000

RANCOCAS VALLEY

ANESTHESIA

700 ROUTE 130 NORTH CINNAMINSON NJ 08077 SUSPENSION 8/20/2003

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 2/10/1945 1043311145 840 STONEWALL CT 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

BOULEVARD


RASCHID, SOHAEL MD 1/12/1957 1104851369 1126 KENNEBEC DRIVE CHAMBERSBURG PA 17201 DISQUALIFICATION 11/20/2015

For verifications


State of New Jersey



105



BIRTH


DATE

EXPIRATION

DATE

RASNER, STEVEN DMD 7/15/1954 1114022803 1055 NORTH PEARL ST BRIDGETON NJ 08401 DISQUALIFICATION 10/16/1984 4/5/2018

RASOULINEJAD, ZAHREH T. DDS PO BOX1217 ALPINE NJ 07620 SUSPENSION 10/20/2003

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

AVENUE

LAS VEGAS NV 89129 SUSPENSION 2/19/2004

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 FPC ALDERSON - GLEN RAY RD ALDERSON WV 24910 DISQUALIFICATION 3/7/2014

REBA, GARY J. DDS 2/17/1947 1285852541 TITUS LANE PLAINSBORO NJ 08536 SUSPENSION 12/20/2007

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

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

AVENUE


REED, STEPHAN NILS DC 7/14/1942 4722 EAST DELL RD PHOENIX AZ 85026 DISQUALIFICATION 6/1/1993

For verifications


State of New Jersey



106



BIRTH


DATE

EXPIRATION

DATE

REEVES, WILBURN C. CREEK RD. BRICK NJ 08724 DISQUALIFICATION 8/10/2007

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

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

REITER, RAYMOND D. MD 1/21/1955 1841447380 405 MURRAY HILL PKWY,

#1023

E. RUTHERFORD NJ 07073 DISQUALIFICATION 10/22/2001

RENNER, ALLISON 1/27/1977 1210 OAK ROAD MANASQUAN NJ 08736 DISQUALIFICATION 3/28/2017

RENZI, CAROLINE M. DO 247 CENTER ST TRENTON NJ 08611 DISQUALIFICATION 12/4/1991

RESTORATION PHARMACY 1385 STUYVESANT AVENUE UNION NJ 07083

DEBARMENT

1/16/2009

REVAN-LEWIS, CHAUNDEL CHHA 2/6/1981 26 NANCY LANE PISCATAWAY NJ 08854 DISQUALIFICATION 2/8/2017

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 STREET WESTFIELD NJ 07090 DISQUALIFICATION 2/9/2017

RIACHI, LABIB MD 9/4/1968 1801846597 42 RUTGERS AVENUE COLONIA NJ 7067 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

For verifications


State of New Jersey



107



BIRTH


DATE

EXPIRATION

DATE

RICHARDS, AARON COUNSEL

OR

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

RIGO, BLADIMIR 3/22/1940 FCI-FORT DIX, PO BOX 2000 JOINT BASE MDL. NJ 08640 DISQUALIFICATION 5/12/2016

RILEY, BRIDGETT PHARM

TECH

1801 EGG HARBOR RD. LINDENWOLD NJ 08021 SUSPENSION 3/20/2003

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 ST. 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, NICOLE AKA

CRESTA, NICOLE

RN 2/11/1983 2009 KICKAPOO TERRACE VINELAND NJ 08361 DISQUALIFICATION 3/28/2017

RIVERA, VIVIANIS CHHA 7/5/1984 519 BRUNSWICK AVENUE TRENTON NJ 08638 DISQUALIFICATION 10/20/2017

RIZVI, SAIYID PHD 100 CRAIG RD., SUITE 104 MANALAPAN NJ 07726 SUSPENSION 4/18/1997

RIZZO, KENNETH RPH 2/16/1965 110 WELLS FARM RD. 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

For verifications


State of New Jersey



108



BIRTH


DATE

EXPIRATION

DATE

ROBACK, MARY LPN 7/29/1954 2517 DUNKSFERRY ROAD,

APT. L203

BENSALEM PA 19020 DISQUALIFICATION 6/20/2018

ROBALINO, JOFFRE MD 6/12/1967 1770634404 PO BOX 1000 CUMBERLAND MD 21501 DISQUALIFICATION 5/28/2013

ROBBERSON JR., KENNETH 8/17/1969 3404 SHORELINE DRIVE WALL TOWNSHIP NJ 07719 DISQUALIFICATION 6/16/2017

ROBBINS, GORDON J. 447 UNION AVENUE PATERSON NJ 07522 DISQUALIFICATION 4/30/1987

ROBBINS, RICHARD G. MD 7/29/1963 551 MILLBURN AVE. 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

ROBINSON, KIM 2/23/1956 594 WALNUT STREET ELIZABETH NJ 07201 SUSPENSION 2/3/2003

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

SOUTHEAST HWY 70

ARCADIA FL 34266 DISQUALIFICATION 12/29/2015

RODRIGUEZ, ARACELY CHHA 4/18/1975 1039 NORTH 35TH STREET CAMDEN NJ 8105 DEBARMENT 5/31/2018

RODRIGUEZ, BEATRIZ 10/8/1967 109 GREENBRIAR AVENUE

BOX157

RICHLAND NJ 08350 SUSPENSION 10/18/2001

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, 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

For verifications


State of New Jersey



109



BIRTH


DATE

EXPIRATION

DATE

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

TECH

12/16/1983 9 SECOND AVENUE NEWARK NJ 07104 DEBARMENT 4/12/2012

ROMANOWSKI, STEVEN PO BOX 1011 UNION NJ 07083 DISQUALIFICATION

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 RD. 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 W. NEW YORK NJ 07903 DISQUALIFICATION 8/1/1996

ROSA, EDDIE MD 3/3/1966 1215045869 796 MT. PROSPECT AVENUE NEWARK NJ 07104 SUSPENSION 2/15/2012

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 MT. PROSPECT AVENUE NEWARK NJ 07104 DISQUALIFICATION 9/17/2013

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/PHAR

M TECH

8/10/1965 99 GROVE AVENUE MAYWOOD NJ 07607 DISQUALIFICATION 2/21/2018 PERMANENT

ROSEN, BURTON DDS 9/22/1930 1939 ROUTE 70 EAST CHERRY HILL NJ 08003 DEBARMENT 5/24/1999

For verifications


State of New Jersey



110



BIRTH


DATE

EXPIRATION

DATE

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

NCTURIST

1/12/1972 332 SOUTH AVENUE EAST WESTFIELD NJ 07090 SUSPENSION 3/20/2005

ROSENSWEET, MARTIN DPM 6/27/1957 FORT DIX FCI, PO BOX 38 FORT DIX 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 RD. 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

SHAW, RICKY

12/10/1972 123 N. 19TH STREET EAST ORANGE NJ 07017 DISQUALIFICATION 10/14/2005

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

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 ST., 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 RD. 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,

APT. 1B

SAYREVILLE NJ 08872 DEBARMENT 6/28/2018

ROYSTER, TAHNESHA CHHA 4/15/1988 30 RIDGE AVENUE NEPTUNE NJ 07753 DEBARMENT 8/24/2017

For verifications


State of New Jersey



111



BIRTH


DATE

EXPIRATION

DATE

ROZO, GLADYS 374B HAMILTON STREET SOMERSET NJ 08873 SUSPENSION 5/14/2007

ROZVAGA, NADEZHDA 11/4/1946 155 ALEXAUKEN CREEK RD. LAMBERTVILLE NJ 08530 SUSPENSION 8/20/2009

RUANE, JOSEPH T. DC 8/16/1955 314 WILLOW DRIVE LITTLE SILVER NJ 07739 SUSPENSION 1/8/1997

RUBINSTEIN, CHARLES RPH 45 LAUREL AVENUE LINWOOD NJ 08221 SUSPENSION 8/20/2006

RUDOLPH, HERBERT MD 11/9/1954 1871633370 317 EAST MAIN STREET TUCKERTON NJ 08087 DEBARMENT 9/14/2016

RUFFIN, SHARALYN CHHA 12/12/1980 OAKDALE VILLAGE TRAILER

#52

CRANBURY NJ 08512 DISQUALIFICATION 2/8/2017

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

DONNA

164 STARBOARD STREET FORKED RIVER NJ 08731 DISQUALIFICATION 5/26/2000

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

RUSSELL JR., BERTRAM R. MD USP HAZELTON, PO BOX 2000 BRUCETON MILLS WV 26525 DEBARMENT 12/28/2014

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

CLEMENTON ROAD

BLACKWOOD NJ 08012 DISQUALIFICATION 10/2/1995

RUSSOMANNO, RAYMOND MD 5/30/1943 1093702532 350 BLOOMFIELD AVENUE BLOOMFIELD NJ 07003 DEBARMENT 11/28/2007

RUTA, EUGENIO DC 4/14/1961 189 6TH AVENUE LONG BRANCH NJ 07740 SUSPENSION 7/21/2008

RUTIGLIANO, MICHAEL MD 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

For verifications


State of New Jersey



112



BIRTH


DATE

EXPIRATION

DATE

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 BOX

0369

HACKENSACK NJ 07601 DISQUALIFICATION 10/28/2015

S. RESES APOTHOCARY 6522 VENTNOR AVENUE VENTNOR NJ 08406 DISQUALIFICATION

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, ANDREW

A.

9/29/1981 108 BRANDON RD. EAST SYRACUSE NY 13057 SUSPENSION 3/20/2012

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, BHAGWAN MD 7/12/1945 1386790665 240 LYNCREST RD. 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 1507 FINNEGANS LANE NEW BRUNSWICK NJ 08902 DISQUALIFICATION 11/16/1998

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

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

For verifications


State of New Jersey



113



BIRTH


DATE

EXPIRATION

DATE

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

SANDERLIN, KATHLEEN RN 4/16/1960 824 SANIKAN TRAIL SOUTHAMPTON NJ 08088 SUSPENSION 10/18/2001

SANDERS, DENISE PHARM

TECH

3/21/1953 4 DREXEL COURT LINDENWOLD NJ 08021 DISQUALIFICATION 7/12/1995

SANDERS, MICHAEL THERAPIS

T

8/29/1964 4 CHERRY RD. NEWTON NJ 07860 SUSPENSION 10/19/2006

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

SANGHERA, ANIL MD 1/14/1950 105 PHEASANT FIELD LANE MOORESTOWN NJ 08057 DISQUALIFICATION 5/20/2009

SANICO, ELAINE D. DPM 122 BRIGHT ST., #1W JERSEY CITY NJ 07302 SUSPENSION 11/19/1997

For verifications


State of New Jersey



114



BIRTH


DATE

EXPIRATION

DATE

SANTA MARIA, DONNA L. RN 7/3/1954 618 CINDER RD. 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

SANTIAGO, RANALDO GIBBSBORO RD. 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 RD. SOUTH TOMS RIVER NJ 08757 DEBARMENT 5/31/2006

SANTIAGO-JIMINEZ,

HERIBERTO

4/12/1955 396 WOODLAND AVENUE SOUTH AMBOY NJ 08879 DISQUALIFICATION 9/19/2011

SANTOS - ARIAS, SIMON MD 10/28/1941 1497721062 10305 NW 7TH COURT PLANTATION FL 33324 DEBARMENT 8/18/2016

SAPERSTEIN, ALAN 30 HIGHLAND RD-DIX HILLS LONG ISLAND 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

SATCHER, WILLIAM 558 ANDERSON AVENUE CLIFFSIDE PARK NJ 07010 DISQUALIFICATION

SAUL, STEPHEN L. DPM 4/2/1971 76 W. JIMMIE LEEDS RD. 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

SAYED, SAQUIB MD 9/14/1965 1609054360 4 TURTLE HOLLOW COURT SICKLERVILLE NJ 08081 DEBARMENT 4/29/2016

SAYED-BAKHATY, ABDEL MD 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

For verifications


State of New Jersey



115



BIRTH


DATE

EXPIRATION

DATE

SCARPITTA, JANET 9/2/1964 92 PEABODY PLACE NEWARK NJ 07104 DISQUALIFICATION 6/15/2001

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 DR. MT. 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

SCHEINER, DAVE E. DPM 12/14/1950 910 BONAPARTE COURT PHILADELPHIA PA 19107 SUSPENSION 7/22/1999

SCHENKEL, CATHERINE

MICHELLE

RN 10/6/1956 87 IRVING AVENUE, APT. 3 LIVINGSTON NJ 07039 DISQUALIFICATION 6/20/2009

SCHENKEL, CATHERINE

MICHELLE

RN 10/6/1956 87 IRVING AVENUE, APT. 3 LIVINGSTON NJ 07039 SUSPENSION 5/30/2010

SCHERING SALES

CORPORATION

2000 GALLOPING HILLS ROAD KENILWORTH NJ 07033 SUSPENSION 10/20/2005

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

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

SCHMUCKER-KARPOW,

CELESTE

MD 4/6/1954 50 MAPLE AVENUE MORRISTOWN NJ 07960 DISQUALIFICATION 12/27/1995

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, 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

For verifications


State of New Jersey



116



BIRTH


DATE

EXPIRATION

DATE

SCHUTT, CHARLES HARDEN 21 PARMLEY RD. TINTON FALLS NJ 07724 DISQUALIFICATION 3/8/1978

SCHWARTZ, EDWARD RPH 3/5/1936 60 SIP AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 8/6/1998 RETIRED

SCHWARTZ, EDWARD RPH 3/5/1936 720 HARMON COVE TOWERS SECAUCUS NJ 07094 DISQUALIFICATION 1/17/2001 RETIRED

SCHWARTZ, EDWARD RPH 3/5/1936 1021 HERALD STREET REDLANDS CA 92374 SUSPENSION 12/20/2000 RETIRED

SCHWARTZ, GEORGE

ROBERT

MD 1/2/1942 PO BOX 1806 SANTA FE NM 87504 SUSPENSION 12/19/2007

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 RD. WINTERSET IA 50273 SUSPENSION 2/20/2002

SCOPELLITI, ALDO R. DC 9/5/1958 1568524049 107 MONMOUTH RD. W. 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 RD., APT. 105 HACKENSACK NJ 07601 SUSPENSION 10/18/2001

SCOTT, MCKENZIE LPN 5/22/1986 457 REDBANK RD. 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 RD. OAKLAND NJ 07436 DISQUALIFICATION 7/13/1988

SCURRY, MARSHAYA PHARM

TECH

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 12/27/1949630 FORT WASHINGTON

AVENUENEW YORK NY 10040 SUSPENSION 12/31/2000

SELIM, HANAN RPH 9/7/1968 47 NORWOOD AVENUE CLIFTON NJ 07011 SUSPENSION 5/30/2000

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State of New Jersey



117



BIRTH


DATE

EXPIRATION

DATE

SEMPLE, IVRY 724 GROVE ST IRVINGTON NJ 07111 DISQUALIFICATION 12/24/1985

SEMPLE, IVRY 472 LAKESIDE AVENUE ORANGE NJ 07050 DISQUALIFICATION 8/14/1986

SENAPE, SAVERIO MD 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 COUNSEL

OR

9/26/1951 471 HIGHLAND AVENUE, APT.

A

COLLINGSWOOD NJ 08108 SUSPENSION 4/29/2003

SENTILLES, JEAN J. MD 11/27/1945 150 W 56TH ST. N 509 NEW YORK NY 10019 DISQUALIFICATION 2/27/1992

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. 6J NEWARK NJ 07108 DISQUALIFICATION 9/20/2012

SEUFERT, ANNA MARIE CHHA 5/8/1990 5139 LAKE WORTH RD. 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

SHAKARJIAN, CARNIG C. DPM 5/9/1962 1720007743 99 KINDERKAMACK RD. 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

SHARMA, RAVINDER MD 2/18/1953 1306947999 3 MARTIN COURT MARTINSVILLE NJ 08836 DEBARMENT 1/22/2016

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

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

For verifications


State of New Jersey



118



BIRTH


DATE

EXPIRATION

DATE

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 S. 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,

MIRIAM

5/8/1930 8215 ABINGDON RD. KEW GARDENS NY 11478 DISQUALIFICATION

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

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 RD. MONROE TWP. NJ 08831 DISQUALIFICATION 5/29/2007

SILMAN, ALEX DDS 4/7/1975 1629319751 3 CLARK PLACE MARLBORO NJ 07746 SUSPENSION 10/22/2010 1/5/2018

SILVA, SANDY COUNSEL

OR

2208 HILLCREST AVENUE PENNSAUKEN NJ 08110 SUSPENSION 4/29/2003

For verifications


State of New Jersey



119



BIRTH


DATE

EXPIRATION

DATE

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

PHARMACY

5532 BERGENLINE AVENUE WEST NEW YORK NJ 07093 SUSPENSION 7/23/1998

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

RD

RINGWOOD NJ 07456 SUSPENSION 11/24/2007

SINGH, SAGGOO MD 3/19/1947 485 S. DOBSON RD., STE. 202 CHANDLER AZ 85224 SUSPENSION 11/20/1995

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

SIRIPURAPU, PADMA MD 5/12/1967 1710061056 1 SCENIC HILLS COURT BELLE MEAD NJ 08502 DISQUALIFICATION 12/30/2014

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

218

ENGLEWOOD NJ 07631 SUSPENSION 8/2/2011

SIVAKANTHA,

SIVAGNANALIN

PSYCH 11/14/1964 1114080165 PO BOX 5503 SOMERSET NJ 08875 DISQUALIFICATION 9/20/2011

SKAGGS, MATTHEW A. 5/31/1972 2127 QUAETHEM DRIVE CHESTERFIELD MO 63005 DISQUALIFICATION 1/20/2012

For verifications


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BIRTH


DATE

EXPIRATION

DATE

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 RD. TOMS RIVER NJ 08753 SUSPENSION 10/18/2001

SLOAN, DEBRA 8/16/1954 31 SCHAAF RD. BLOOMSBURY NJ 08804 DEBARMENT 8/12/2012

SLOTNICK, SINO 1556 RIVER RD. 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

AVENUE

MORRISVILLE PA 19067 DISQUALIFICATION 6/22/2007

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, LAKESIA CHHA 5/4/1983 2030 RIVERSIDE DRIVE, APT.

10B


SMITH, LARRY 9/9/1960 183 SOUTH HIGHLAND

AVENUE, APT. 1

YORK PA 17404 DISQUALIFICATION 11/20/2015

SMITH, LAURA LPN 10/5/1959 1051 OLD FREEHOLD RD. 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 RD. SAN MARCOS TX 78666 DISQUALIFICATION

SMITH-DORSEY, JULIA RN 12/2/1969 37 WINFIELD DRIVE PARSIPPANY NJ 07054 DEBARMENT 8/2/2017

SMOLER, JOSEPH M. MD 158 HAMILTON AVENUE PASSAIC NJ 07055 DISQUALIFICATION 6/1/1993

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

For verifications


State of New Jersey



121



BIRTH


DATE

EXPIRATION

DATE

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 RD. U. SADDLE RIVER NJ 07458 SUSPENSION 6/20/2000

SOKHA, BORIS 7/26/1954 FCI FORT DIX FORT DIX 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 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

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

DRIVE

CASTLE ROCK CO 80104 DISQUALIFICATION 8/28/2017 PERMANENT

SONG, YOUNG 37 DEANNA DRIVE EAST HANOVER NJ 07936 DISQUALIFICATION 7/19/2010 7/19/2015

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 &

SURGICAL

2230 S. CROSKEY STREET PHILADELPHIA PA 19145 DISQUALIFICATION 4/19/1992

SOUTHERN OCEAN

PEDIATRICS AND FAMILY

MEDICINE

1346664893 1100 ROUTE 72 WEST, SUITE

304

MANAHAWKIN NJ 08050 SUSPENSION 1/27/2017 4/27/2017

For verifications


State of New Jersey



122



BIRTH


DATE

EXPIRATION

DATE

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

BREKKE BEST

RN 6/10/1981 35 WOODROW AVENUE FRANKLIN LAKES NH 03235 DISQUALIFICATION 2/20/2018

SPAIN, ANTHONY B. DMD 5/12/1961 1451316098 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 THERAPIS

T

6/30/1949 176 EVERGREEN STREET HILLSDALE NJ 07642 SUSPENSION 11/20/2003

SPAVLIK, LAURIE R. 8/3/1968 200 EAST GRANT AVENUE SOMERDALE NJ 08083 SUSPENSION 4/19/2001

SPECIALTY CLINICAL

LABORATORY

299 ACADEMY STREET JERSEY CITY NJ 07306 DISQUALIFICATION 12/1/1998

SPECTOR, IOSIF G. MD 54 INDIAN DRIVE WOODCLIFF LAKE NJ 07675 SUSPENSION 9/20/2000

SPEDALIERE, CARMINE MD 10/27/1923 1601 KENNEDY BLVD. NORTH BERGEN NJ 07407 DISQUALIFICATION 7/19/1999

SPIGNER, AKOSUA RPH 10/25/1960 941 LINCOLN AVENUE GLEN ROCK NJ 07452 DEBARMENT 5/15/2014

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,

APT. 2


SPLITTER, SAMUEL R. MD 4/24/1914 1742 MARYLAND AVENUE CAPE MAY NJ 08204 DISQUALIFICATION 5/4/1998

SPYRIDON-MARKER,

KAREN

25 ELKINTON RD. ALLOWAY NJ 08001 DISQUALIFICATION 10/20/2002

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

ELIZABETH

RN 8/31/1962 1348 MILLENNIUM COURT TOMS RIVER NJ 08753 DISQUALIFICATION 5/20/2010

STANLEY, JAMES R. 4/7/1959 PO BOX 38, FCI FORT DIX NJ 08640 SUSPENSION 12/20/2001

For verifications


State of New Jersey



123



BIRTH


DATE

EXPIRATION

DATE

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 &

MEDI-COACH

PO BOX 2100 WEST PATERSON NJ 07424 DISQUALIFICATION 1/15/1987

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 1 ROUND HILL RD. WASHINGTONVILLE NY 10992 DISQUALIFICATION 6/14/1984

STEFANELLI, DANETTE DC 7/5/1967 1831245760 91 EAGLE ROCK AVENUE, APT.

A

ROSELAND NJ 07068 DISQUALIFICATION 10/28/2015

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

STREET

BROOKLYN NY 11232 DISQUALIFICATION 7/20/2015 PERMANENT

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

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 RD., APT. D-

12

SPRINGFIELD NJ 07081 DEBARMENT 1/22/2016

STEPHENS, ALICIA T. PHARM

TECH

10/9/1980 5322 RIVERSIDE STATION BL SECAUCUS NJ 07094 SUSPENSION 11/20/2010

For verifications


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124



BIRTH


DATE

EXPIRATION

DATE

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


STIER, ERIC G. DO 891 OLENTANGY RD. FRANKLIN LAKES NJ 07417 DEBARMENT 3/6/2000

STILL, DAWN AKA DAWN

ATKINS

CHHA 9/17/1988 697 EVERETT STREET CAMDEN NJ 08104 DISQUALIFICATION 3/6/2018

STILLWAGON-AHLERS,

DAWN

COUNSEL

OR

11/15/1969 SUNSET LAKE RD. HARDWICK NJ 07825 SUSPENSION 10/20/2008

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

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 ST. 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 RD. SECAUCUS NJ 07094 DISQUALIFICATION 3/5/1998

STRINE JR., WALTER M. 173 ROSE VALLEY RD. 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 RD. SCOTCH PLAINS NJ 07076 DISQUALIFICATION 3/24/1995

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State of New Jersey



125



BIRTH


DATE

EXPIRATION

DATE

STRUM, MORTON W. 1360 ARBORDALE RD. PHILADELPHIA PA 19151 DISQUALIFICATION

SUGGS, SHANTAYA CHHA 10/8/1989 115 HALSTED STREET EAST ORANGE NJ 07018 DEBARMENT 12/26/2017

SUH, JEFFREY ACCUPU

NCTURIST

10/19/1959 1336523497 FORT DIX FCI, PO BOX 2000 JOINT BASE MDL. NJ 08640 DISQUALIFICATION 9/23/2016

SULAIMON, TANFEEK CHHA 10/12/1983 321 GARFIELD AVENUE TRENTON NJ 08629 DISQUALIFICATION 1/22/2018

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

APARTEMENTS

FLEMINGTON NJ 08822 DISQUALIFICATION 7/14/2017

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

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 ST. 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

28

CAMP HILL PA 17011 DISQUALIFICATION 11/20/2015

SZARSZEWSKI, MARK A. RPH 6 MARIGOLD CT. EDISON NJ 08820 SUSPENSION 9/20/2005

SZTYBEL, ELVIRA 35 PEACHTREE RD. OAKHURST NJ 07755 DISQUALIFICATION 7/18/2001

T & N PHARMACEUTICAL

CO.

90 WASHINGTON STREET EAST ORANGE NJ 07017 SUSPENSION 9/22/2000

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 CT. JERSEY CITY NJ 07305 DISQUALIFICATION 6/30/2010 2/5/2018

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BIRTH


DATE

EXPIRATION

DATE

TADROS, AMIR RPH 8/22/1977 6 ALEXANDER COURT, APT. 6N JERSEY CITY NJ 07305 DEBARMENT 12/20/2012 2/5/2018

TAFT, ARNOLD 333 NORTH BROAD STREET ELIZABETH NJ 07028 SUSPENSION 7/21/1997

TAMEKA FORD CHHA 11/27/1970 600 ELM STREET CAMDEN NJ 08102 DISQUALIFICATION 1/31/2017

TANDLER, ROBERT OD 8/21/1950 1104812924 792 GREEN LANE UNION NJ 07013 DEBARMENT 4/29/2016 10/27/2017

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

HYGIENIS

T

26 COOMES STREET NORWICH NY 13815 DEBARMENT 12/2/2012

TARASEVICH, LISA LPN 4/20/1961 206 LAKEHURST AVENUE,

APT. B

NATIONAL PARK NJ 08063 SUSPENSION 9/19/2002

TARKAS, SURBHI 8 CARLTON COURT EAST BRUNSWICK NJ 08816 SUSPENSION 6/23/2004

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

TAYLOR, BARBARA AKA

MONDELO, BARBARA

12/14/1965 363 KENTWOOD BLVD BRICK NJ 08724 DEBARMENT 10/24/2008

TAYLOR, JANICE CHHA 3/14/1953 66 DUFFIELD DRIVE SOUTH ORANGE NJ 07079 DISQUALIFICATION 2/8/2017

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

For verifications


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127



BIRTH


DATE

EXPIRATION

DATE

TELGHEDER, MARGARET 7/24/1954 75 SPRING VALLEY RD 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 BLVD PALISADE PARK NJ 07650 DISQUALIFICATION

TERPENNING, CLARENCE PHD 303 CARTER RD. 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

TECH

4/1/1963 300 NORTH BLACK HORSE

PIKE, APT. B-1

RUNNEMEDE NJ 08078 DISQUALIFICATION 12/26/2016

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 RD. OAK RIDGE NJ 07438 DEBARMENT 10/15/2012 10/15/2015

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 AV, APT. #3 IRVINGTON NJ 07111 SUSPENSION 4/20/1999

THOMAS-MCNAIR, GLORIA 6/17/1939 590 BELLVUE AVENUE TRENTON NJ 08618 DISQUALIFICATION 12/21/1999

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 1255381443 18 LAFAYETTE CIRCLE TOTOWA NJ 07512 DEBARMENT 12/5/2013 12/17/2015

For verifications


State of New Jersey



128



BIRTH


DATE

EXPIRATION

DATE

THOTTEMPUDI, VENKATA 11/4/1967 13 VINCENT BEHAN BLVD EDISON NJ 08837 DISQUALIFICATION 4/12/2012

THOTTEMPUDI, VENKATA 11/4/1967 13 VINCENT BEHAN BLVD EDISON NJ 08837 DISQUALIFICATION 9/9/2013

TICE, LINDSEY LPN 3/19/1982 20 PARVINS MILL RD. BRIDGETON NJ 08302 SUSPENSION 9/20/2005

TIDD, MILES LPN/RN 26 CORAL TREE CT. TRENTON NJ 08648 SUSPENSION 6/20/2005 1/9/2012

TISCORNIA, KIMBERLY RN 12/9/1972 18 TORNE MOUNTAIN RD. WEST MILFORD NJ 07480 SUSPENSION 6/20/2005

TOBACK, BARRY RPH 4/8/1952 1375 RIVER RD. EDGEWATER NJ 07020 SUSPENSION 6/19/2003

TOFANI, NANCY 8/3/1954 114 COUNTY RD. 513 PITTSTOWN NJ 08867 SUSPENSION 6/14/2000

TOMLIN, CANDICE PHARM

TECH

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 RD. ANNANDALE NJ 08801 SUSPENSION 11/12/2009

TORIBIO, ANTHONY X-RAY

TECH

11 BYRON DRIVE LOPATCONG NJ 08865 SUSPENSION 9/28/2001

TORO, NORMARY CHHA 11/16/1989 1173 ATLANTIC AVENUE, APT.

B

CAMDEN NJ 08104 DISQUALIFICATION 2/8/2017

TORPPEY, JONI LPN 4/5/1959 28 CHURCH ROAD NEWTON NJ 07860 DISQUALIFICATION 6/5/2017

TORRES, FRANCES 437 STUYVESANT AVENUE

APT

IRVINGTON NJ 07111 DISQUALIFICATION 4/27/2007

TORRES, JAIME 9/13/1950 14TH STREET, U-25 VILLARICA BAYAMO PR 00959 SUSPENSION 6/7/2000

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

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State of New Jersey



129



BIRTH


DATE

EXPIRATION

DATE

TORRESS, KRISTINA CHHA 8/28/1991 53 STEGMAN STREET, APT. #4 JERSEY CITY NJ 07305 DISQUALIFICATION 1/24/2018

TOSCANO, SYLVIA 13 NORTHGATE WAY TOMS RIVER NJ 08753 DEBARMENT 8/12/2013

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

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 RD. W. ORANGE NJ 07052 SUSPENSION 9/20/2005

TRAYNOR, PATRICK 6/22/1941 2314 WOODLAND RD. ABINGTON PA 19001 DEBARMENT 12/5/2003

TREGO-CAMPION, ANITA RPH 8/15/1960 136 S. FELLOWSHIP RD. MAPLE SHADE NJ 08052 SUSPENSION 10/20/2005

TREMO, GREGORY RPH 11/21/1966 13276 WHIPPINGHAM

PARKWAY

NEW CARROLTON VA 23314 SUSPENSION 11/20/2006

TRENTACOSTA, GREG S. DC 10/9/1971 1720293079 1565 RATZER RD. 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 RD. 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 BLVD 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 RD. EDISON NJ 08817 DEBARMENT 4/27/2004

TUMAS, MARY DC 9/13/1953 537 FISK AVENUE BRIELLE NJ 08730 DISQUALIFICATION 7/28/2014

For verifications


State of New Jersey



130



BIRTH


DATE

EXPIRATION

DATE

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

TURTON, IAN LPN 7/6/1968 52 BAY SHORE DRIVE TOMS RIVER NJ 08753 DISQUALIFICATION 4/24/2018

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

UHLIG, CYNTHIA 7/26/1957 204 WYOMING STREET WESTFIELD NJ 07090 SUSPENSION 9/20/2006

UHUNMWANGHO,

OZIEGBE

CHHA 11/29/1996 818 SOUTH 18TH STREET NEWARK NJ 07108 DISQUALIFICATION 9/12/2017

UKO, BRIDGET CHHA 4/19/1956 47 HEMPSTEAD DRIVE SOMERSET NJ 08873 DISQUALIFICATION 7/14/2017 PERMANENT

UNION CITY DIAGNOSTIC

LAB

2201 BERGENLINE AVENUE UNION CITY NJ 07007 DEBARMENT 6/10/2001

UNITED DENTAL CENTER 35 WALLINGTON AVENUE WALLINGTON NJ 07057 SUSPENSION 9/18/2003

UNITED DIAGNOSTIC LAB,

INC.

100 CRAIG RD., SUITE 104 MANALAPAN NJ 07726 SUSPENSION 4/18/1997

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

TRANSPORTATION

845 BERGEN AVENUE JERSEY CITY NJ 07306 DISQUALIFICATION 6/14/1994

URVINA ESTRADA, GINA CHHA 5/18/1961 169 JACKSON STREET PASSAIC NJ 07055 DISQUALIFICATION 7/31/2017

US CLINICAL LABORATORY,

INC.

185 S. EUCLID STREET PASADENA CA 91101 DEBARMENT 4/22/1997

V.C. LABORATORY, INC. 9 COURTLAND AVENUE STATEN ISLAND NY 10301 DISQUALIFICATION 3/24/2003

VALDES JR., ALFREDO TNT

MEDICAL

10/27/1974 1780644427 135 HAZEL STREET, APT. 65 CLIFTON NJ 07011 DISQUALIFICATION 1/29/2018

VALENCIA, RAFAEL MD 4/28/1950 1518045525 146 LAKEVIEW DRIVE GIBBSBORO NJ 08026 DISQUALIFICATION 11/9/2017 PERMANENT

For verifications


State of New Jersey



131



BIRTH


DATE

EXPIRATION

DATE

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,

INC.

350 WEST MARKET STREET NEWARK NJ 07107 SUSPENSION 4/29/1977

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

DRIVE

BENSALEM PA 19020 DISQUALIFICATION 6/28/2017

VARSOS, ARISTIDES G. MD 28 47 37TH ST. ASTORIA NY 11103 DISQUALIFICATION 2/24/1986

VASKO, OLGA 3 PARKWOOD DRIVE SOUTH AMBOY NJ 08879 DISQUALIFICATION 7/10/2003

VASOYA, PRAVIN MD 3/27/1967 1770665135 METROPOLITAN DETENTION

CTR. #41549-050


VASSERMAN, ALEKSANDR PARAME

DIC

10/7/1983 851 RED LION RD., APT. E1 PHILADELPHIA PA 19115 DISQUALIFICATION 11/20/2015

VASSERMAN, IRINA 11/30/1962 851 RED LION RD., 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 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

LABORATORY, INC.

904D OAK TREE ROAD SOUTH PLAINFIELD NJ 07080 DEBARMENT 12/1/1999

For verifications


State of New Jersey



132



BIRTH


DATE

EXPIRATION

DATE

VENKATRAM, PRABHAKAR MD 3305 VILLAGE DRIVE AVENEL NJ 07001 DEBARMENT 11/28/1998

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

VICENTI, CARMILLA C. MD 40-15 QUAIL RIDGE RD. PLAINSBORO NJ 08536 SUSPENSION 3/18/1999

VICIOSO, MARGARITA MD 4/9/1959 1922058932 7801 BUSTLETOWN AVENUE,

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 THERAPIS

T

11/8/1953 9030 SW 29TH TERRACE MIAMI FL 33155 SUSPENSION 3/20/2005

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 RD. DANBURY CT 06811 DEBARMENT 7/5/2001

VIRZI, JOSEPH PO BOX 164 JAMESBURG NJ 08831 SUSPENSION 1/9/1996

VISCOMI, DOMINIC A. DDS 10/29/1941 926 DUCK POND RD. NEWTON NJ 07860 DEBARMENT 5/31/2001

VISCONTI, PAUL A. DO 8/2/1940 1538492400 120 OLD COMMACK RD. 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

VOYTENKO, CONSTANTINE DC 10/10/1971 1174556229 2780 WEST 5TH STREET, APT.

12A


For verifications


State of New Jersey



133



BIRTH


DATE

EXPIRATION

DATE

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 RD. BRICKTOWN NJ 08723 DISQUALIFICATION 6/21/1979

WALKER, ASHLEY RN/PA 5/1/1989 841 HILLTOP RD. ERIE PA 16509 DISQUALIFICATION 11/20/2015

WALKER, BARBARA D. CHHA 120 N. ORATON PARKWAY,

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 DEBARMENT 9/15/2017

WASHINGTON JR.,

ANKOMO

CHHA 7/30/1993 174 EAST 6TH STREET CLIFTON NJ 07011 DISQUALIFICATION 2/8/2017

WASHINGTON, JOHN 9/13/1951 2 TUERS PLACE MONTCLAIR NJ 07043 SUSPENSION 4/29/1997

WASHINGTON,

WAH'TAYVIA

CHHA 11/28/1991 144 BIDWELL AVENUE JERSEY CITY NJ 07305 DISQUALIFICATION 2/8/2017

WASSEF, ADEL A. MD 2/10/1932 123 SOUTH MUNN AVENUE EAST ORANGE NJ 07019 SUSPENSION 2/18/1998

WATSON, LORENZO PHARM

TECH

8/7/1984 500 ADAMS LANE NORTH BRUNSWICK NJ 08902 DISQUALIFICATION 11/21/2016

WATSON, MARC C. MD 2/29/1948 1578605929 912 POMPTON AVENUE, #9B1 CEDAR GROVE NJ 07009 SUSPENSION 4/1/2001

WATSON, TRACEY L. LPN 12/23/1970 1 GRUMMAN AVENUE, APT.

4F


For verifications


State of New Jersey



134



BIRTH


DATE

EXPIRATION

DATE

WATZMAN, MARC

HOWARD

MD 7/6/1966 PO BOX 1000 LORETTO PA 15940 DEBARMENT 8/30/2007

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 DR BANGOR PA 18013 SUSPENSION 12/19/2002

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 RTE. 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 RD. MONROE TWP. 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


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 RD. MIDDLETOWN NJ 07748 DEBARMENT 12/16/2015

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

DRIVE

MADISON

TOWNSHIP


WERTHEIM, HOWARD RPH 8/18/1948 19 KNOB HILL RD. 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

For verifications


State of New Jersey



135



BIRTH


DATE

EXPIRATION

DATE

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 DR. LAKEWOOD NJ 08701 SUSPENSION 10/20/2002

WESLEY, JOSEPH W. MD 10/9/1948 246 N FRANKLIN TPK 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 PHARMACY 1548326812 11 DOGWOOD LANE EAST HANOVER NJ 07936 DISQUALIFICATION 3/29/2017 PERMANENT

WESTFIELD AVENUE

PHARMACY

156 COUNTRY FARM ROAD MARLTON NJ 08053 DISQUALIFICATION 9/26/2013

WESTON, MARC OD 4/18/1937 16 BARNETT RD LAWRENCEVILLE NJ 08648 DISQUALIFICATION 6/1/1993

WHETSTONE, RHONDA CHHA 8/9/1983 73 PEABODY PLACE NEWARK NJ 07104 DISQUALIFICATION 7/27/2017

WHITE, PHAEDRA J. RN 3/5/1966 1107 N SALINA ST. #2 SYRACUSE NY 132082 DEBARMENT 11/20/2008

WHITE, WAYNE RPH 4/14/1960 1366717514 11001 NORTHWEST 17TH

AVENUE

MIAMI FL 33167 DISQUALIFICATION 11/20/2015

WHITE, WENDELL CHHA 4/15/1969 106B CHAUCER RD. MOUNT LAUREL NJ 08054 DEBARMENT 10/25/2003

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

WHITMORE, SHARON T. 1/8/1967 51 DOVER ST., 2ND FLOOR NEWARK NJ 07106 DEBARMENT 9/19/2002

WHITMORE, SHARON T. 1/8/1967 51 DOVER STREET 2ND FLOOR NEWARK NJ 07106 DISQUALIFICATION 8/15/2005

WHITNEY, MARIS AKA

WERBIN, MARIS

RPH 8/11/1957 126 RIVER DRIVE LAKE HIAWATHA NJ 07034 SUSPENSION 8/20/2006

WHITTAKER, MICHELLE CHHA 6/4/1992 801 1/2 4TH AVENUE NEPTUNE NJ 07753 DEBARMENT 8/29/2017

For verifications


State of New Jersey



136



BIRTH


DATE

EXPIRATION

DATE

WIJETILAKA, ROHAN MD 12/8/1948 1821058694 FORT DIX FCI - PO BOX 2000 FORT DIX NJ 08640 DISQUALIFICATION 5/20/2015

WIKLINSKI, STEPHEN L. DC 10/1/1964 1659454981 DEWOLF RD. 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, 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 AVE STE201 ENGLEWOOD NJ 07631 SUSPENSION 7/27/1998

WILLIAMS JR., OTIS A. MD 11/9/1962 293 CLASSON AVE., APT. 2R BROOKLYN NY 11205 SUSPENSION 2/2/1999

WILLIAMS, AMY 5/14/1967 1126 COLLINS RD. 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, APT.

A16


WILLIAMS, CRAIG DMD 3/30/1957 175 CROSS KEYS RD. 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

WILLIAMS, HELIEN 1/25/1986 29 STRATFORD PLACE, APT. 2F NEWARK NJ 07104 DISQUALIFICATION 8/26/2013

WILLIAMS, JAMES LLOYD THERAPIS

T

5/26/1966 208 NORTH CHESTNUT

STREET

SCOTTDALE PA 15683 DISQUALIFICATION 11/20/2015

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

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State of New Jersey



137



BIRTH


DATE

EXPIRATION

DATE

WILLIAMS, MARCUS MD 6/19/1958 1619057734 1500 LOCUST STREET, APT.

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 ST IRVINGTON NJ 07111 DISQUALIFICATION 12/24/1985

WILSON, TAKEELA CHHA 8/31/1979 135 BERGEN AVENUEM APT. 2-

E


WILSON, TASHA M. CHHA 8/25/1971 124 YORK ST., APT.64 SALEM NJ 08079 DISQUALIFICATION 1/6/2006

WINDMILLER, EDWARD DDS 5/30/1961 1871914036 3731 WALNUT STREET, APT. A HARRISBURG PA 17109 DISQUALIFICATION 12/29/2015

WINEGARDEN, ROBERT F. DMD 1/21/1949 1306056981 1 ROUTE 27, PARSONAGE RD EDISON NJ 08820 SUSPENSION 9/20/1999

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

BOULEVARD

NEWARK NJ 07102 SUSPENSION 6/5/1997

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,

BETHANY

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 RD. FAIRLAWN NJ 07410 DISQUALIFICATION 4/29/1996

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State of New Jersey



138



BIRTH


DATE

EXPIRATION

DATE

WITEK JR., JOSEPH T. MD 4/28/1969 1063606838 3625 AVENIDA MADEIRA BRADENTON FL 34210 DEBARMENT 10/17/2000

WITHINGTON, PAMELA RN 9/9/1960 5 CHERRYVILLE RD. FLEMINGTON NJ 08822 SUSPENSION 6/20/2005

WITMAN, LEEANN 12/30/1964 SCI CAMBRIDGE SPRINGS, 451

FULLERTON AVENUE

CAMBRIDGE

SPRINGS


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 RD. YORK PA 17403 DISQUALIFICATION 11/20/2015

WOLFE, WILLIAM MD 10/5/1963 1003872912 27 ROCKINGHAM DRIVE MARLTON NJ 08053 DISQUALIFICATION 9/12/2016

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

JUSTICE

10/4/1962 32 DAYTON STREET, APT. B1 NEWARK NJ 07114 DISQUALIFICATION 9/13/2013

WOROSILO, SHARON MD 12/18/1960 1000 AVENUE AT PORT

IMPERIAL

WEEHAWKIN NJ 07086 DISQUALIFICATION 11/8/2017

WOUND HEALING

ASSOCIATES

3111 ROUTE 38 MOUNT LAUREL NJ 08054 SUSPENSION 11/19/2005

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

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 GLEN RAY RD. BOX A ALDERSON WV 24910 DEBARMENT 9/19/2011

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

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State of New Jersey



139



BIRTH


DATE

EXPIRATION

DATE

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 ROAD

CLEMONTON NJ 08021 DEBARMENT 3/5/2018

WYLIE, JOHN D. RPH 11/28/1950 7306 WOODVIEW WAY MALVERN PA 19355 SUSPENSION 7/20/2004

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 ST, APT. 2 ALLENTOWN PA 18103 SUSPENSION 8/20/2001 1/5/2018

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 CRT FARMINGDALE NJ 07727 SUSPENSION 9/20/2000

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

TECH

5/11/1963 504 STEVENS RD. LANDING NJ 07050 SUSPENSION 5/20/2008

YAW, GAYFORD A. PHARM

TECH

5/11/1963 504 STEVENS RD. LANDING NJ 07850 DISQUALIFICATION 9/24/2008

YELCICK, JOHN MD 5/15/1965 635 WILLOW GREEN LITITZ PA 17543 DEBARMENT 7/28/2014

YEPES, LINA CHHA 1/19/1980 2105 NEW YORK AVENUE,

BSMT 3

UNION CITY NJ 07087 DISQUALIFICATION 2/20/2017

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 RD. 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

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State of New Jersey



140



BIRTH


DATE

EXPIRATION

DATE

ZAK, FELIX 4/13/1952 825 E. 9TH STREET BROOKLYN NY 11230 DISQUALIFICATION 1/9/2001

ZAMAN, TANVIR PHARM

TECH

9/25/1980 205 DAVIS AVENUE ABSECON NJ 08201 DISQUALIFICATION 7/18/2018

ZAMLOOT, PHILIP 10/28/1969 150 PARK ROW NEW YORK NY 10007 SUSPENSION 7/20/2005

ZARRELLI, MICHAEL

#67206-050

12/13/1966 FCI FORT DIX - PO BOX 2000 JOINT BASE MDL. NJ 08640 DISQUALIFICATION 9/29/2017

ZASLOW, LAWRENCE RPH 12/7/1953 323 SOCIETY HILL BLVD., APT

1

CHERRY HILL NJ 08003 DISQUALIFICATION 10/25/2016

ZAWAHIR, MEEYAPILLAI 2/22/1939 91 KNICKERBOCKER RD. TENAFLY NJ 07670 SUSPENSION 9/20/2006

ZELTSER, LAZAR 4/11/1973 2333 MORRIS AVENUE, UNIT

D3

UNION NJ 07083 SUSPENSION 6/22/1998

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

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

FACILITY, PO BOX 866

WRIGHTSTOWN NJ 08562 DISQUALIFICATION 2/28/2018 PERMANENT

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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