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Subject Number 046-1405 March 2021 Removals from the List of Authorized Health Care Providers

Subject Numbers Regarding Health Provider Authorizations

May 13, 2021

Pursuant to Workers' Compensation Law § 13-b, a provider must be licensed and registered with the New York State Education Department in order to maintain a Workers' Compensation Board authorization(s).

The following have been removed from the list of providers authorized to treat injured workers and/or perform independent medical examinations within the New York State workers' compensation system based on information provided by the New York State Education Department indicating that they do not currently have an active license to practice medicine in New York State.

NAME LAST KNOWN CITY OF PRACTICE AUTHORIZATION NUMBER* EFFECTIVE DATE
Ardila Gatas, Jessica Alexandra Stony Brook 296725-5W March 10, 2021
Barrow, Daniel Webster Dobbs Ferry PT042655-1W March 10, 2021
Bennett, Christopher Joseph Waukesha 263602-5W March 10, 2021
Berdufi, Klejdja Lyndhurst PT042672-6W March 10, 2021
Bernstein, William Harvey New City 091619-7W March 10, 2021
Bertrand, Bruce Kenneth Sterling 199697-4W March 10, 2021
Bien, Alexander Gregory Albany 278738-0W March 10, 2021
Blumenthal, Jesse Arthur New York 087016-2W March 10, 2021
Boddhula, Sowmya Cooperstown 288270-2W March 10, 2021
Brasch, Robert Charles Latham 207050-6W March 10, 2021
Brustein, Jerome Marc Vero Beach 177218-5W March 10, 2021
Casimir, Stephen A. Endicott 087816-5W March 10, 2021
Chastanet, David Adrien White Plains 101275-6W March 10, 2021
Darer, Jacobo White Plains 137078-2W March 10, 2021
De Sousa, Jerslin Rockaway Beach C12739-1I March 10, 2021
Dean, Shannon Lee Rochester 289101-8W March 10, 2021
Defrank Castro, Joseph Miguel Johnson City 262824-6W March 10, 2021
Delacruz-Gomez, Rafael Antonio Queens Village 185160-9W March 10, 2021
Diaz, Fredie Colon Albuquerque 199224-7W March 10, 2021
Diokno, Raul D. Loudonville 128527-9W March 10, 2021
Fallis, Karen Roslyn 131055-6W March 6, 2021
Frater, Robert William Mayo Bronxville 094718-4W March 10, 2021
Goldstein, Marshall F. Pittsfield 124596-8W March 10, 2021
Hamdi, Mark Elwood Glens Falls S12146-7W March 10, 2021
Degonzague, Kirsten Hamilton Albany C09755-2W March 10, 2021
Hershkowitz, David W. Bronx C11234-4W March 10, 2021
Hertz, Ronny West Nyack 139417-0W March 10, 2021
Iglesias, Richard Henry Bronx C04822-5W March 10, 2021
Kandalaft, Souheil I. Hartsdale 103071-7W March 10, 2021
Kaur, Gurvinder Highland 289953-2W March 10, 2021
Kay, Chester Jay Boca Raton 087163-2W March 10, 2021
Khan, Walayat Dansville 115189-3W March 10, 2021
Kheti, Yatin Cortland 279715-7W March 10, 2021
Klapholz, Mark Bernard Great Neck 143452-1W March 10, 2021
Klein, Ronald Steven Hannacroix 166846-6W March 10, 2021
Kommu, Swati Ramchandra Jersey City PT042386-3W March 10, 2021
Kressner, Michael Stewart Cortland 135411-7W March 10, 2021
Lagasse, Robert Scott Stamford 176911-6W March 10, 2021
Lebowitz, Mark Allan Brooklyn 156441-8W March 10, 2021
Lerner, Jean M. Brooklyn C03750-9W March 10, 2021
Lim, Suzanne Lee New York 149372-5W March 10, 2021
Modonia, Vincent Victor Garden City 071433-7W March 10, 2021
Mallon, William Kinney, Jr. Stony Brook 282233-6W March 10, 2021
Mendizabal, Edgar Plainview 111434-7W March 10, 2021
Messing, Samuel Louis Boca Raton 080971-5W March 10, 2021
Meyappan, Thiagarajan Tarrytown 163096-1W March 10, 2021
Mierlak, Julian A. Brooklyn 138709-1W March 10, 2021
Montellese, Christopher George Monterey C11176-7W March 10, 2021
Nayak, Ramesh B. New York 123187-7W March 10, 2021
Nori, Venkatesh Lynbrook 200931-4W March 10, 2021
O'Neill, Karen Ann Northport C05982-6W March 10, 2021
Pagnozzi, Paul Joseph Hurley 175032-2W March 10, 2021
Perri, Daniel Middletown 200502-3B March 10, 2021
Perry, Russell Joseph Bronx 198433-5W March 10, 2021
Porter, Taylor Main Wolcott PT042469-7W March 10, 2021
Resnik, Jack Cayuga 099098-6W March 10, 2021
Rosenblum, Seth Tucson C01949-9B March 10, 2021
Rostami, Parifar Syracuse 296682-8W March 10, 2021
Salky, Barry A. Snowmass Village 114785-9W March 10, 2021
Savarino, Daniel Stephen Freehold 243935-4W March 10, 2021
Shah, Syed Jibran Mississauga 289028-3W March 10, 2021
Shareef, Shakeel Rahman Cleveland 194774-6W March 10, 2021
Shiekh, Habib Ullah Attica 130339-5W March 10, 2021
Silverberg, Arnold I. Brooklyn 089730-6W March 10, 2021
Sonpal, Girishkumar M. Bayside 122605-9W March 10, 2021
Tabo, Libertine Magallon Staten Island PT042510-8 March 10, 2021
Tamar, Kyron C. Lowville 132492-0W March 10, 2021
Thornburg, Robert Patrick Rochester 227256-5W March 10, 2021
Tirrell, Paul Charles Cooperstown 176553-6W March 10, 2021
Vizner, Tatjana Brooklyn 141831-8W March 10, 2021
Weinberg, Zwi Scarsdale 140292-4W March 10, 2021
Weinstock, Jed Coopertown 270823-8W March 10, 2021
Weintraub, Steven Jeffrey Melville 161909-7W March 10, 2021
Wolin, David A. Piermont 121284-4W March 10, 2021
Xu, Annie H. Albany OT019971-1W March 10, 2021

*Providers authorized to treat and perform independent medical examinations have an authorization number ending in B. Providers authorized to only treat have an authorization number ending in W. Providers authorized to only perform independent medical examinations have an authorization number ending in I.

These providers are prohibited from rendering treatment and care to injured workers and/or from performing independent medical examinations. Reports submitted for services rendered prior to the effective date are valid but are invalid for any services rendered on or after that date. Requests to cross-examine any of the above for services rendered prior to the effective date should not be denied due to the removal of their authorizations.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.

Clarissa M. Rodriguez
Chair