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Subject Number 046-1532 May 2022 Removals from the List of Authorized Health Care Providers

Subject Numbers Regarding Health Provider Authorizations

July 28, 2022

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
Adler, Robert Ira Lady Lake 098881-6W May 18, 2022
Agopovich, Arsenio Troy 081390-7W May 18, 2022
Akhtar, Amina Waldorf 156421-0W May 18, 2022
Allard, Felicia D. Little Rock 305132-3W May 18, 2022
Babu, Tara Manyam Bellevue 260538-4W May 18, 2022
Bansal, Nidhi S. Abington Township 278315-7W May 18, 2022
Bartoszek, David M. Spotsylvania 161389-2W May 18, 2022
Bass, Douglas H. New York 165753-5W May 18, 2022
Bierstock, Samuel Richard Delray Beach 130657-0W May 18, 2022
Blum, Isaac Scarsdale 111159-0W May 18, 2022
Boon, Robert C. Brockport 089959-1W May 18, 2022
Boudreau, William James Norwich 186378-6W May 18, 2022
Braga, Jose N. Hyde Park 109820-1W May 18, 2022
Braver, Alexander Manalapan 199890-5W May 18, 2022
Broad, Robert Daniel Bridgeport S04164-0W May 18, 2022
Bromberg, Beth Shapiro Stamford 164082-0W May 18, 2022
Burke, Chris Stephen Rochester 248708-0W May 18, 2022
Cameron, Airlie Ann Carruthers Bronxeville 089903-9W May 19, 2022
Carlucci, Leonard Anthony Jersey City C02839-9W May 19, 2022
Carter Maurice C New York 089267-9W May 19, 2022
Chang Howard Arverne 296636-4W May 19, 2022
Chernilas, Joseph Z. New York 158058-8W May 23, 2022
Chin, Yin Lee Lindenhurst 121401-4W May 19, 2022
Crea, Maria Antoinette Lewiston 081018-4W May 19, 2022
Crowther, John Christian Longboat Key 097191-1W May 19, 2022
Curtis, Theodore Hertzel Mount Kisco 259317-6W May 23, 2022
Deipolyi, Amy New York 274375-5W May 19, 2022
Delamarter, Tara Marie Vestal PA019975-2W May 19, 2022
Dunton, Robert Frederick Lake George 242934-8W May 19, 2022
Evangelista, Jonald Boyles Southgate PT032653-8W May 19, 2022
Fazio, John Raymond Georgetown 191793-9W May 19, 2022
Fishbein, Gerald M. Fairlawn S02293-9W May 19, 2022
Frank, Judith May Goshen 104527-7W May 19, 2022
Fujimura, Osamu Los Angeles 216984-5W May 19, 2022
Gandhi, Krishnakumari New York 145265-5W May 19, 2022
Gordon, Steven Wittenberg Overland Park 189397-3W May 19, 2022
Grand, Sheldon Allen Delmar S02845-6W May 19, 2022
Graziano, Jessica M. Pearl River PT029948-7W May 19, 2022
Hackett, Charles Peter Point Lookout 163238-9W May 19, 2022
Hallac, Ismet Williamsville 098249-6W May 19, 2022
Hammer, Joseph New York S10348-1W May 19, 2022
Harryman, Robert M. Watertown 158390-5W May 19, 2022
He, Lan Forest Hill 210578-1W May 19, 2022
Hollander, Chelsea Michelle Mount Kisco 257313-7W May 19, 2022
Hossain, Mohammed Saha-Adat Patchogue 118034-8W May 19, 2022
Ian, Diorio James Anthony Cooperstown C01606-3W May 19, 2022
Johnston, Mark R. Syracuse 149047-3W May 19, 2022
Katz, Brian E. Spring Valley C00848-2W May 19, 2022
Kaufman, Andrew Greg Newark 180253-7W May 19, 2022
Korrol, Charles Reuben Piermont 095661-5W May 19, 2022
Kostakoglu, Shields Lale New York 209952-1W May 19, 2022
Kumar, Rajesh Vestal 284837-2W May 19, 2022
La Vine, James Joseph Baldwin 080270-2W May 23, 2022
Lehman, Martin A. West Hempstead 082928-3W May 23, 2022
Leistner, Ken E. East Rockaway C02576-4W May 23, 2022
Liu, Hsien Kwang Staten Island 114090-4W May 23, 2022
Lobbia, Loretta E. Liverpool S08837-7W May 23, 2022
Mancke, Brian David Bronx 302746-5B May 23, 2022
Mattei-Gonzalez, Gabriel New York 286142-5W May 23, 2022
Mehta, Shruti Kirti Columbia PT044037-0W May 23, 2022
Meyerberg, Alan Staten Island P03274-4W May 23, 2022
Meyers, Bernard Lawrence Schenectady 081160-4W May 23, 2022
Millmond, Steven Harris Peoria 192057-8W May 23, 2022
Mukhtyar, Dilip Ratilal Bronx 111790-8W May 23, 2022
Murphy, Marilyn Diane Syracuse S10982-7W May 23, 2022
Neuschatz, Joseph J. Port Jefferson 091849-0W May 23, 2022
Patel, Bipinchandra R. Johns Creek 137389-3W May 23, 2022
Patel, Hasmukh P. Bayport 125226-1W May 23, 2022
Patel, Jayant P. Flushing 157572-9W May 23, 2022
Patel, Kriya Balvant Jersey City 285245-7B May 23, 2022
Patel, Rajendrakumar M. Warsaw 151555-0W May 23, 2022
Perillo, Joseph Thomas Geneva P03480-1W May 25, 2022
Saadvandi, Terence M. Netuchen P05475-9W May 25, 2022
Schlifstein, Todd Russell New York 205272-8B May 25, 2022
Schlossberg, Harvey Forest Hills S04834-8W May 25, 2022
Shahin, Naji Abi Brooklyn 117258-4W May 25, 2022
Shapiro, Kenneth S. East Hampton 127358-0W May 25, 2022
Sheikh, Mushtaq A. Elmira 120820-6W May 25, 2022
Sherry, Richard G. Watertown 126687-3W May 25, 2022
Shinohara, Sachiko Yonkers PT032532-4W May 25, 2022
Slotwiner, Paul New York 091563-7W May 25, 2022
Smith, Brittany Brooklyn PT044059-4W May 25, 2022
Spavento, Perry Joseph Carl Norwich 166084-4W May 25, 2022
Stamm, David B. Poughkeepsie P03132-8W May 25, 2022
Stern, Leon Boca Raton 142944-8W May 25, 2022
Stewart, Maxine Claudia Gilbert C12374-5W May 25, 2022
Suarez, Manuel Domingo Fort Myers 206844-3W May 25, 2022
Sweet, Richard David Purchase 103167-3W May 25, 2022
Thota, Srinivasa Sarvabhouma Newburg 268939-6W May 25, 2022
Turcotte, Jan K. Watertown 143676-5W May 25, 2022
Varma, Chelikani V. P. Depew 133009-1W May 25, 2022
Velasquez, David Brooklyn 294615-0W May 25, 2022
Veress, Frank Morrisonville 093375-4W May 25, 2022
Warski, Patricia Lynn Norwich P03819-0W May 25, 2022
Wasserman, Michael A. New York C03023-9W May 25, 2022
Weinstein, Mark Jeffrey Bethpage 141364-0W May 25, 2022
Wellington, Louis Roslyn 095619-3W May 25, 2022
White, Patricia Anne Basking Ridge 160317-4W May 25, 2022
Wiesenfeld, Rachel Forest Hills PT044283-0W May 25, 2022
Wilett, Jerome Rene Fayetteville S05499-9W May 25, 2022
Wilson, Michael F. Buffalo 187615-0W May 25, 2022
Wosnitzer, Brian Edward Kew Gardens 266100-7W May 25, 2022
Zeman, Bethann Marie Hurley PA023220-7W May 25, 2022
Zhao, Alexander Livingston PT044048-7W May 25, 2022
Zhavoronkov, Ilya G. Rochester 212591-2W May 25, 2022
Zikry, Yasser Saad Jamesville 172235-4W May 25, 2022

*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