opr provider listing - husky health program1023216280 aguirre esther 75 seminary hill rd. carmel ny...

63
NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number 1063572014 ABASTILLAS ANNA LIZA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-518-8800 1619252202 ABBOTT ETHAN 4422 3RD AVE BRONX NY 10457-2545 800-645-3055 1023130705 ABBOTT STEVEN 1022 STORRS RD STORRS CT 06268-1247 860-429-2051 1487855128 ABEL ERIKA 1 TAMPA GENERAL CIRCLE TAMPA FL 33606-3571 888-851-7590 1427309947 ABRAHAM BINCY 100 WOODS ROAD VALHALLA NY 10595-1108 914-493-7632 1356824742 ABRAHAM MANJU 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-604-8555 1235114026 ABRAMSON DAVID 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764 1437567260 ACHARYA YAM 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500 1659547271 ACIDERA ANNA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000 1821338393 ACOSTA WILLIAM 300 GEORGE ST SUITE 901 NEW HAVEN CT 06511-6662 203-785-2095 1225480031 ADIBA AFIFA 230 S FRONTAGE ROAD YSOM NEW HAVEN CT 06519-1124 203-737-7129 1649667106 ADIGUN AYODOLA YALE CHID STUDY CENTER 230 SOUTH FRONTAGE ROAD NEW HAVEN CT 06519-1124 203-737-7129 1508894676 ADLER MARY 701 ENFIELD STREET ENFIELD MEDICAL ASSOC ENFIELD CT 06082-2961 860-741-6572 1750690392 AFONSO DIANA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000 1417210394 AFONSO TANIA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721 1497937486 AGAG RICHARD 30 SHELBURN RD STAMFORD CT 06902-9314 203-276-7058 1447326871 AGGARWAL AMITA 322 MAIN ST PORTLAND CT 06480-1512 860-342-3303 1609974047 AGOSTIN DOMINICK 15 OLD RIDGEFIELD ROAD WILTON CT 06897-3013 203-762-9907 1871907642 AGRAWAL SABHYATA 300 CEDAR STREET SLEEP MEDICINE ,TAC S425 NEW HAVEN CT 06520-8057 203-785-3207 1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-299-5702 1407240559 AHMED AADIL 20 YORK STREET DEPT OF PATHOLOGY NEW HAVEN CT 06510-3220 203-688-9503 1679950984 AHMED JAFREEN 263 FARMINGTON AVENUE MC 1410 FARMINGTON CT 06030-1410 929-444-5230 1457886459 AHMED KASHIF 230 S FRONTAGE RD YALE CHILD STUDY CENTER NEW HAVEN CT 06519-1124 203-737-7129 1982157400 AHMED MAHMOUD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500 1568872224 AHMED NAZIR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000 1558467266 AJJAGOTTU VIJAYA 555 WILLARD AVE NEWINGTON CT 06111-2631 860-666-6951 1497252845 AKUO ALPHONSE 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055 1568462760 AKUS JAN WILLIAM W BACKUS HOSPITAL 326 WASHINGTON STREET NORWICH CT 06360-2740 860-889-8331 1770998775 AL JAMMALY RIYADH 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6664 203-785-2095 1982834313 ALANG NEHA 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-4318 1982917944 ALBANESE JULIE 149 NORTH ST WATERVILLE ME 04901-4995 800-645-3055 1376703322 ALBANESE KRISTA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 845-216-0320 1386674331 ALBANESE MARGARET 1676 SUNSET AVENUE UTICA NY 13502-4849 800-633-2243 1336581347 ALBUJA PONCE ANA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195 1891866059 ALCANTARA CADILLO DELLY 555 WILLARD AVENUE NEWINGTON CT 06111-2631 203-932-5711 1104204734 ALDERSON MARK 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348 1841415858 ALEXANDER ASHLI 11 UPPER RIVERDALE ROAD SW RIVERDALE GA 30274-2615 918-429-7518 1558467027 ALEXIADES MICHAEL 535 EAST 70TH STREET NEW YORK NY 10021-4823 646-797-8471 1619472586 ALFANO PETER 95 SARGENT STREET BELCHERTOWN MA 01007-9881 413-323-7212 1891851648 ALGON SIBEL 1011 VETERANS MEMORIAL PARKWAY RIVERSIDE RI 02915-5061 401-432-1000 1699253591 ALHUSAINI SAUD 20 YORK STREET YNHH NEUROLOGY NEW HAVEN CT 06510-3220 203-688-9503 1558894816 ALI HANA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095 1932134285 ALI RAYSHMA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721 1093187395 ALLEN CHELSEA 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140 HUSKY Health Connecticut Page 1 of 63 6/11/2020 7:00:06 AM OPR Provider Listing (Ordering/Prescribing/Referring)

Upload: others

Post on 05-Jun-2020

2 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1063572014 ABASTILLAS ANNA LIZA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-518-8800

1619252202 ABBOTT ETHAN 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1023130705 ABBOTT STEVEN 1022 STORRS RD STORRS CT 06268-1247 860-429-2051

1487855128 ABEL ERIKA 1 TAMPA GENERAL CIRCLE TAMPA FL 33606-3571 888-851-7590

1427309947 ABRAHAM BINCY 100 WOODS ROAD VALHALLA NY 10595-1108 914-493-7632

1356824742 ABRAHAM MANJU 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-604-8555

1235114026 ABRAMSON DAVID 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1437567260 ACHARYA YAM 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1659547271 ACIDERA ANNA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1821338393 ACOSTA WILLIAM 300 GEORGE ST SUITE 901 NEW HAVEN CT 06511-6662 203-785-2095

1225480031 ADIBA AFIFA 230 S FRONTAGE ROAD YSOM NEW HAVEN CT 06519-1124 203-737-7129

1649667106 ADIGUN AYODOLA YALE CHID STUDY CENTER 230 SOUTH FRONTAGE ROAD NEW HAVEN CT 06519-1124 203-737-7129

1508894676 ADLER MARY 701 ENFIELD STREET ENFIELD MEDICAL ASSOC ENFIELD CT 06082-2961 860-741-6572

1750690392 AFONSO DIANA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1417210394 AFONSO TANIA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1497937486 AGAG RICHARD 30 SHELBURN RD STAMFORD CT 06902-9314 203-276-7058

1447326871 AGGARWAL AMITA 322 MAIN ST PORTLAND CT 06480-1512 860-342-3303

1609974047 AGOSTIN DOMINICK 15 OLD RIDGEFIELD ROAD WILTON CT 06897-3013 203-762-9907

1871907642 AGRAWAL SABHYATA 300 CEDAR STREET SLEEP MEDICINE ,TAC S425 NEW HAVEN CT 06520-8057 203-785-3207

1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1619482510 AGYAPONG FAUSTINA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-299-5702

1407240559 AHMED AADIL 20 YORK STREET DEPT OF PATHOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1679950984 AHMED JAFREEN 263 FARMINGTON AVENUE MC 1410 FARMINGTON CT 06030-1410 929-444-5230

1457886459 AHMED KASHIF 230 S FRONTAGE RD YALE CHILD STUDY CENTER NEW HAVEN CT 06519-1124 203-737-7129

1982157400 AHMED MAHMOUD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1568872224 AHMED NAZIR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1558467266 AJJAGOTTU VIJAYA 555 WILLARD AVE NEWINGTON CT 06111-2631 860-666-6951

1497252845 AKUO ALPHONSE 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1568462760 AKUS JAN WILLIAM W BACKUS HOSPITAL 326 WASHINGTON STREET NORWICH CT 06360-2740 860-889-8331

1770998775 AL JAMMALY RIYADH 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6664 203-785-2095

1982834313 ALANG NEHA 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-4318

1982917944 ALBANESE JULIE 149 NORTH ST WATERVILLE ME 04901-4995 800-645-3055

1376703322 ALBANESE KRISTA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 845-216-0320

1386674331 ALBANESE MARGARET 1676 SUNSET AVENUE UTICA NY 13502-4849 800-633-2243

1336581347 ALBUJA PONCE ANA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1891866059 ALCANTARA CADILLO DELLY 555 WILLARD AVENUE NEWINGTON CT 06111-2631 203-932-5711

1104204734 ALDERSON MARK 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1841415858 ALEXANDER ASHLI 11 UPPER RIVERDALE ROAD SW RIVERDALE GA 30274-2615 918-429-7518

1558467027 ALEXIADES MICHAEL 535 EAST 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1619472586 ALFANO PETER 95 SARGENT STREET BELCHERTOWN MA 01007-9881 413-323-7212

1891851648 ALGON SIBEL 1011 VETERANS MEMORIAL PARKWAY RIVERSIDE RI 02915-5061 401-432-1000

1699253591 ALHUSAINI SAUD 20 YORK STREET YNHH NEUROLOGY NEW HAVEN CT 06510-3220 203-688-9503

1558894816 ALI HANA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1932134285 ALI RAYSHMA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1093187395 ALLEN CHELSEA 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140

HUSKY Health Connecticut Page 1 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 2: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1003934282 ALLEN CHRISTOPHER 95 HARBOR RD SUITE 955 SOUTHPORT CT 06890-3306 203-838-1678

1669457735 ALLEN REBECCA 101 DUDLEY STREET PROVIDENCE RI 02905-1464 401-273-0641

1629068440 ALLEN ROBIN 555 WILLARD AVE NEWINGTON CT 06111-2631 866-808-7921

1497870273 ALLIGER JASON 1389 WEST MAIN ST SUITE 208 WATERBURY CT 06708-3115 203-757-1287

1073924528 ALLISON LAUREN 1563 POST ROAD EAST WILLOWS PEDIATRIC GROUP WESTPORT CT 06880-5602 203-319-3939

1003800236 ALLOWAY JANET 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1457820243 ALMASSI ARIEA 2 MEDICAL CENTER DRIVE SPRINGFIELD MA 01107-1270 413-794-5600

1790977650 ALMHANNA KHALDOUN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1902985344 ALONSO NOEL 201 EAST SAMPLE ROAD POMPANO BEACH FL 33064-3502 623-580-6309

1558701540 ALSAMMAN MOHD AMER 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1578815957 ALSAMMAN OMAR 100 MCGREGOR STREET MANCHESTER NH 03102-3730 603-314-4771

1679537450 ALTEMUS MARGARET 950 CAMPBELL AVE BUILDING 2, ROOM 7-165 WEST HAVEN CT 06516-2770 646-209-6277

1972763027 ALTER TODD 1501 N CAMPBELL AVE TUCSON AZ 85724-5146 520-694-8888

1336201300 ALTORELLI ALPHONSE 125 NEW MILFORD TURNPIKE NEW PRESTON CT 06777-1703 860-868-7318

1295781854 ALVAREZ ANNE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1861506917 ALVERO RUBEN 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1417499906 ALVES CAITLIN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1164682613 AMANTI CRISTOPHER 1 BOSTON MEDICAL CENTER BCD 1ST FLOOR BOSTON MA 02118-2908 978-777-9998

1952322802 AMANULLAH SIRAJ 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6779

1851601611 AMARAL KERRI 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9167

1215257126 AMASS TIMOTHY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4001

1386933216 AMAZAN-RODNEY GERLY 400 CAPITAL BLVD MC DIAGNOSTIC OF CT PC ROCKY HILL CT 06067-3576 415-547-5151

1942363189 AMBLE PAUL SILVER STREET MIDDLETOWN CT 06457-7023 860-262-5000

1053571844 AMESQUITA MICHAEL 1001 SAM PERRY BLVD FREDERICKSBURG VA 22401-4453 800-645-3055

1255975975 AMIN RAMI 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1538322250 AMINI RICHARD 2800 E. AJO WAY TUCSON AZ 85713-6204 801-256-1900

1316032295 AMMERMAN DONALD 84 HOSPITAL AVENUE DANBURY CT 06810-6047 203-792-0400

1164598322 AMSTER SUSAN 1563 POST ROAD EAST WESTPORT CT 06880-5602 203-319-3939

1619325503 ANAND RAVI 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1174751101 ANDERSON ASHLEIGH 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-8130

1003839291 ANDERSON BETH 67 SAND PIT ROAD DANBURY CT 06810-4032 203-743-7246

1083773170 ANDERSON CASANDRA 800 E 28TH ST MINNEAPOLIS MN 55407-3723 612-262-3851

1639513948 ANDERSON SANDRA 67 SANDPIT RD. STE. 308 DANBURY CT 06810-4032 203-743-7264

1710390646 ANDREWS LAURA 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1235509670 ANDY TERYN 131 NEW LONDON TURNPIKE GLASTONBURY CT 06033-2246 860-798-8158

1962791103 ANEST TRISHA 2 BERNARDINE DRIVE NEWPORT NEWS VA 23602-4404 419-226-4343

1235246307 ANGEL LUIS 530 1ST AVE, HCC 12 NEW YORK NY 10016-6402 516-663-3018

1841631488 ANGEVINE PATRICIA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1265855167 ANGLIN TAMIKA 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1275513442 ANIS NADEEM 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1861430332 ANKER ANTHONY 1001 SAM PERRY BLVD FREDERICKSBURG VA 22401-4453 800-645-3055

1144590191 ANNULLI RICHARD 1037 VALLEY RD NEW CANAAN CT 06840-2818 203-594-1947

1811354897 APHOLT MARY 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2752

1265732051 APOSTOLIDOU EIRINI 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-5891

HUSKY Health Connecticut Page 2 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 3: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1891742904 ARCHER CLARK 5655 FRIST BOULEVARD HERMITAGE TN 37076-2053 727-507-2501

1811916257 ARCIERO THOMAS 1127 W MAIN STREET WATERBURY CT 06708-2765 203-754-2225

1073921847 AREY KATIE 759 CHESTNUT STREET BAYSTATE EMERGENCY MEDICINE SPRINGFIELD MA 01107-1619 413-794-3233

1114300498 ARIAS-MAGALLONA SARAH 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1639596752 ARTIME CLAUDIA 701 ENFIELD STREET ENFIELD CT 06082-2961 860-741-6572

1497163190 ARYAL BISHOW 725 NORTH STREET PITTSFIELD MA 01201-4109 413-881-5427

1194767681 ASAAD GHAZI 72 NORTH STREET DANBURY CT 06810-5648 203-748-1200

1205087608 ASARE JOHN 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-8515

1790949337 ASCHER JOEL 500 SOUTH CLEVELAND AVENUE WESTERVILLE OH 43081-8971 800-645-3055

1225519077 ASEMNOR AFUA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-796-7545

1467553248 ASHRAF MAHBOOB 285 SHAKER ROAD ENFIELD ENFIELD CT 06082-1800 860-253-8000

1467971044 ASSELIN EMILY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1225321375 ASSELIN NICHOLAS 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1447678164 ASUZU KAMMARAUCHE 230 S FRONTAGE ROAD NEW HAVEN CT 06519-1124 203-737-7129

1740265727 ATHANASIAN EDWARD 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1326283532 ATHOURISTE OLPHABINE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1083977458 ATTAALLA MINA 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1306887856 ATTAR JESSICA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1538663430 ATTAR RYAN 1817 BLACK ROCK TURNPIKE SUITE 205 FAIRFIELD CT 06825-3546 203-717-1339

1538391842 ATTMORE SUSAN 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 615-372-0078

1285629162 ATWELL FRANTZ 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1851722797 AUGUSTINE ANNIE 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-528-2565

1669899894 AUSTIN SHANE 3000 CORAL HILLS DRIVE CORAL SPRINGS FL 33065-4108 480-977-3271

1447580840 AUTH TARA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-376-6616

1992236822 AYANKOLA OLUSOLA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1013975945 AYRES ROGER 177 POST ROAD WEST SUITE #5 WESTPORT CT 06880-4652 203-341-0706

1861463895 AZZOLI CHRISTOPHER 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-1000

1376067884 BABB MACKENZIE 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5370

1225357601 BACKER KATHY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1174595847 BACKMAN KENNETH 55 WALLS DRIVE STE. 405 FAIRFIELD CT 06824-5163 203-259-7070

1114946217 BADERAK HARRIS 169 MARTIN AVE EPHRATA PA 17522-1724 800-645-3055

1376030403 BAER CHADD 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5161

1033222195 BAEZ AMADO 3100 EAST FLETCHER AVE. TAMPA FL 33613-4613 800-645-3055

1972982957 BAHEKAR PRATIK 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1003256587 BAIG MUHAMMAD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1184645301 BAIK RANIA 602 ROUTE 169 WOODSTOCK CT 06281-1835 860-821-3406

1134125834 BAIN LAURIE 357 HARTFORD TURNPIKE VERNON CT 06066-4800 860-871-9441

1932184934 BAINS MANJIT 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1982853529 BAKER JOANNE 55 FRUIT ST BOSTON MA 02114-2696 617-726-8071

1891337770 BAKER MATTHEW 3300 MAIN STREET 3RD FL, SUITE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1407828296 BAKER WILLIAM ONE BOSTON MEDICAL CENTER PL. BOSTON MA 02118-2908 617-414-5481

1942615612 BAKKER TAMECA 2776 CLEVELAND AVE. FORT MYERS FL 33901-5864 800-645-3055

1790917805 BALASURIYA LILANTHI 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1184727752 BALLA ROBERT 928 FARMINGTON AVENUE WEST HARTFORD CT 06107-1929 860-233-2322

HUSKY Health Connecticut Page 3 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 4: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1265599583 BALTER ANDREW 234 CHURCH STREET SUITE 1201 NEW HAVEN CT 06510-1881 203-787-5938

1134145170 BALZARETT JOSEPH 8206 LEESBURG PIKE #207 VIENNA VA 22182-2612 703-893-8585

1871709147 BANDOW MD GRACE 761 MAIN AVE SUITE 102 NORWALK CT 06851-0500 860-282-4128

1740320266 BANIUKIEWICZ ANDREA 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1912218918 BANKI ALI 2928 MAIN ST SUITE 200 GLASTONBURY CT 06033-2135 860-659-2779

1184193294 BANKS JOSEPH 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1093753923 BAPANA EMMANUEL 1656 CHAMPLIN AVE UTICA NY 13502-4830 800-633-2243

1003054966 BAQAI AISHA 500 WESTCHESTER AVENUE WEST HARRISON NY 10604-3200 646-227-3764

1609326552 BARABAN INNA 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5161

1669769550 BARASZ JONAH 546 S BROAD ST SUITE 3A MERIDEN CT 06450-1034 203-630-1312

1609161637 BARBER SEAN 593 EDDY STREET STE 101 PROVIDENCE RI 02903-4923 401-444-6779

1215154117 BARBERIE MICHAEL 4 BERKSHIRE BLVD BETHEL CT 06801-1001 203-826-3142

1063868099 BARBOZA JEWEL 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1336115567 BARMECHA JITENDRA 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1851446843 BAROWSKY JEREMY 500 WEST PUTNAM AVENUE SUITE 400 GREENWICH CT 06830-6000 203-340-1115

1255369799 BARR ALAN 555 NEWFIELD AVENUE STAMFORD CT 06905-3330 203-324-9800

1487897716 BARRETT LAUREL 1 GENERAL STREET LAWRENCE MA 01841-2961 978-683-4000

1871792606 BARRIO ANDREA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1457707333 BARRON DANIEL 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1538281670 BARTH DAVID 52 BEACH RD # 104 SUITE 104 FAIRFIELD CT 06824-6017 203-254-2000

1124382445 BARTH PETER 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1417021577 BARTOLONE CYNTHIA 2150 BLACK ROCK TPKE FAIRFIELD CT 06825-3239 203-333-2060

1558462366 BARTON JANET 75 SEMINARYHILL RD. CARMEL NY 10512-1921 845-225-3400

1619950581 BARUCH JAY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1932210127 BASCETTA SEBASTIAN 138 R-MARKET SQUARE NEWINGTON CT 06111-2916 860-666-8461

1497868053 BASH JEFFREY 410 SAYBROOK ROAD SUITE 100 MIDDLETOWN CT 06457-4444 860-685-8950

1235127754 BASTIAENS LEO 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1588875603 BASU ELLEN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1275749384 BATES ADAM 160 ALLEN STREET RUTLAND VT 05701-9977 802-747-1633

1134351927 BATES JENNIFER BLYTHEDALE CHILDREN''S HOSPITA 95 BRADHURST AVE VALHALLA NY 10595-1637 914-831-2498

1871906347 BATOG ADAM 169 MARTIN AVE EPHRATA PA 17522-1724 800-645-3055

1073834321 BAXI NAMISH 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1447695457 BAZAN ISABEL 789 HOWARD AVE. YNHH PULMONARY & CC NEW HAVEN CT 06519-1304 203-785-3207

1568551927 BAZOS ANDREW 2 RIVERVIEW DR. DANBURY CT 06810-6268 203-702-6680

1720217789 BEACH ANDREW 593 EDDY STREET PROVIDENCE RI 02905-4513 401-793-4102

1093805632 BEARMAN GONZALO 1250 EAST MARSHALL STREET RICHMOND VA 23298-5051 800-645-3055

1437129624 BEAUBOEUF ANDRE 600 ST JOHNSBURY ROAD LITTLETON NH 03561-3442 603-444-9271

1255745501 BEAUBRUN ANNELIESE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1447212816 BEAUDOIN DONALD 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1992920086 BEAUDOIN FRANCESCA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1477838324 BECK ALICIA 455 BOSTON POST ROAD OLD SAYBROOK CT 06475-1505 860-388-9799

1265448203 BECK RICHARD 58 DIVISION ST DANBURY CT 06810-7753 203-743-4834

1932177425 BECKA-FITZPATRICK MARIA 636 DEL PRADO BLVD CAPE CORAL FL 33990-2692 800-645-3055

1689865834 BEECHY CHRISTOPHER 636 DEL PRADO BLVD CAPE CORAL FL 33990-2695 800-645-3055

1699186262 BEEKMAN RACHEL 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06512-6663 203-785-2095

HUSKY Health Connecticut Page 4 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 5: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1962781492 BEELER KATHARINE 325 9TH AVE SEATTLE WA 98104-2420 206-744-9888

1700120268 BEGIN MONICA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1336185768 BEHRENDS ROBERT 60 WESTWOOD AVENUE SUITE 210 WATERBURY CT 06708-2460 203-597-0633

1558593442 BEKAL KARTHIK 95 SCOVILL ST. WATERBURY CT 06706-1735 203-465-5292

1558768945 BELBASE SANTOSH 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1407807852 BELLIZZI JOHN 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1992755987 BELMAN ALEC 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1063945665 BENDER RICCI 300 GEORGE YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1205816634 BENNETT MARY 100 CENTURY DRIVE WORCESTER MA 01606-1244 508-762-5400

1396724563 BENNETT MICHAEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1942596630 BERBERI NISIDA 8714 5TH AVE BROOKLYN NY 11209-5204 516-663-2818

1407084544 BERENBERG THOMAS 1201 WEST MAIN STREET WATERBURY CT 06708-3105 203-573-4803

1669714523 BERGAMO CARA 4077 5TH AVE. SAN DIEGO CA 92103-2105 800-645-3055

1770996563 BERGER ELISABETH 725 NORTH STREET PITTSFIELD MA 01201-4019 413-881-5427

1841355377 BERGHERR THERESA 357 WHITNEY AVE SUITE 204 NEW HAVEN CT 06511-2364 203-562-6400

1558529875 BERGLUND KRISTINA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1134445760 BERGMAN MICHAEL STAMFORD HOSPITAL 1 HOSPITAL PLAZA STAMFORD CT 06902-3602 203-276-6156

1386701753 BERHANU KABAYE 150 KINGSLEY LANE NORFOLK VA 23505-4602 804-627-5573

1245625300 BERK JUSTIN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1992739643 BERKMAN MATTHEW 2800 E. AJO WAY TUCSON AZ 85713-6204 385-695-1936

1104110030 BERKOWITZ LAUREEN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1437276987 BERKSON ALAN 431 NEW HAVEN AVE MILFORD CT 06460-3615 203-877-5106

1164860896 BERKSON SARAH 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1265409726 BERLAND ROBERT 100 WELLS ST SUITE 1B HARTFORD CT 06103-2920 860-278-8937

1538149463 BERNBACH MARC 171 GRANDVIEW AVENUE SUITE 104 WATERBURY CT 06708-2524 203-753-2048

1063711596 BERNIER CAROL 1 HEALTH CIRCLE LEXINGTON VA 24450-2448 800-645-3055

1457395980 BERNSTEIN SHELLY 450 BROOKLINE AVENUE LW204 DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5917

1407247752 BERTA GABRIELLA 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1558828426 BERTONE AMY 200 KENNEDY MEMORIAL DRIVE WATERVILLE ME 04901-4526 800-645-3055

1508935024 BERTUCH ELIZABETH 1236 MAIN ST SUITE 202A HOLYOKE MA 01040-2955 413-532-6777

1306831391 BERV DOUGLAS 60 WASHINGTON AVENUE SUITE 102 HAMDEN CT 06518-3203 203-407-6444

1649531179 BEUCHER MEGHAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1194945634 BEVERIDGE PHYLLIS 915 RIVER ROAD MIDDLETOWN CT 06457-3921 860-704-4097

1982866596 BEYER CHRISTINA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1720348170 BHARATIA NIKITA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1578781316 BHATT REENA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-7334

1023461621 BHATTARAI SHREEYUKTA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1730231705 BIANCHI CHRISTOPHER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1720642812 BIANCHI-WILBERDING BRITTANY 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1326371261 BIELAWSKI MARK 555 WILLARD AVENUE VETERANS ADMINISTRATION NEWINGTON CT 06111-4272 866-808-7921

1275626889 BIERLY JOHN 625 HOPMEADOW STREET SIMSBURY CT 06070-2449 860-658-5552

1174899512 BILLAKOTA SANTOSHI 223 EAST 34TH STREET NEW YORK NY 10016-4852 516-663-2818

1679558944 BILSKY MARK 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1992795207 BINDER WILLIAM 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

HUSKY Health Connecticut Page 5 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 6: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1982016366 BINNALL BRIAN 759 CHESTNUT STREET S4604 SPRINGFIELD MA 01107-1619 413-794-4013

1285832386 BINNS GREAR LORRAINE 555 WILLARD AVE PRIMARY CARE NEWINGTON CT 06111-2631 866-808-7921

1619170404 BITAR SOUAD 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1487880084 BIVENS MATTHEW 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1861406142 BLACK JANETTE 69 SHERMAN STREET FAIRFIELD CT 06824-5821 203-255-1545

1629124060 BLACK ROBERT 330 BLAKE CIR HAMDEN CT 06517-0300 203-624-2428

1861931008 BLACKMER ALEKSANDRA 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1437562444 BLACKWOOD BENJAMIN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1467591552 BLAIR CHARLES 836 FARMINGTON AVENUE SUITE 221C WEST HARTFORD CT 06119-1505 860-523-1451

1851796999 BLANKS DORIAN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-6297

1205241973 BLAY MEGHAN 1423 N JEFFERSON AVE SPRINGFIELD MO 65802-1917 918-203-0114

1619210473 BLEVINS JASON 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1982717450 BLOCKER WESLEY 5000 HENNESSY BLVD. BATON ROUGE LA 70808-4375 800-645-3055

1760757017 BLOND BENJAMIN 20 YORK STREET YNHH NEUROLOGY NEW HAVEN CT 06510-3220 203-688-4242

1659582419 BLOOM DAVID 1060 DAY HILL ROAD WINDSOR CT 06095-5719 860-688-5595

1760697635 BLOOM KATHERINE 55 WALLS DRIVE STE. 405 FAIRFIELD CT 06824-5163 203-259-7070

1063647832 BLUVSTEIN JUDITH 223 E 34TH STE 207 NEW YORK NY 10016-4852 512-767-6140

1750301982 BOCCIARELLI PAUL 506 CROMWELL AVE SUITE 203 ROCKY HILL CT 06067-1836 860-529-8582

1811964026 BODEN SCOTT 415 SILAS DEANE HIGHWAY WETHERSFIELD CT 06109-2119 860-563-1400

1750676177 BOFFA MICHAEL 8714 5TH AVE BROOKLYN NY 11209-5230 512-767-6140

1619075173 BOHOMEY JEAN 500 ENTERPRISE DRIVE 500 ENTERPRISE ROCKY HILL CT 06067-3913 860-221-0799

1154656999 BOISVERT CATHY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1811464043 BOLDUC KAITLYN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1043738131 BOMBARDIER MARK 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1063729697 BOND NESTOR 725 NORTH STREET PITTSFIELD MA 01201-4109 413-447-2752

1043387384 BOND STEVEN 34 DALE ROAD SUITE 208 AVON CT 06001-3659 860-677-0079

1114083664 BONYAI EILEEN 501 CRESCENT ST SCSU COUNSELING CENTER EN 219 NEW HAVEN CT 06515-1355 203-392-8861

1316935034 BOOLBOL ROBERT 11 SOUTH ROAD STE. 250 FARMINGTON CT 06032-2484 860-674-0222

1174930382 BORDEN LEANNE 48 SANDERSON STREET SUITE 200 GREENFIELD MA 01301-2778 413-773-2680

1619397676 BORGOVAN THEODOR 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1972997138 BORTZ CHRISTINA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-5700

1770623639 BOSSIO DEBRA 100 DANBURY RD, SUITE 102 RIDGEFIELD CT 06877-4122 203-431-4443

1881856755 BOUCAI LAURA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1811962988 BOUCHER WENDY 140 ACADEMY STREET PRESQUE ISLE ME 04769-3102 800-645-3055

1982638375 BOURQUE VICTORIA 55 NYE ROAD SUITE 102 GLASTONBURY CT 06033-1281 860-657-3056

1205920295 BOURQUE JR JESSE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1972943652 BOVE JOSEPH 703 MAIN ST PATERSON NJ 07503-3079 973-754-2956

1619067303 BOWMAN MELISSA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1851741581 BOYD RYAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1316289754 BOYKIN BRITTNEY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4300

1740206309 BOYLE LISA 297 PROMENADE STREET PROVIDENCE RI 02908-5720 401-490-6452

1316070691 BRACCI BRIAN 391 SHAKER ROAD ENFIELD CT 06082-2376 860-763-6580

1679568349 BRADLEY DARIN 289 COUNTY ROAD WINDSOR VT 05089-9000 802-674-7333

1932182615 BRADSHAW KENNETH 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

HUSKY Health Connecticut Page 6 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 7: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1659609584 BRADY REBECCA 170 HAZARD AVE ENFIELD CT 06082-4520 860-749-2022

1285659177 BRAGDON ALLEN 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1730183146 BRAMWIT STEVEN 125 STRAWBERRY HILL AVENUE SUITE 103 STAMFORD CT 06902-2536 203-348-7797

1467975151 BRANCO TYLER 2344 BOSTON ROAD WILBRAHAM MA 01095-1104 413-596-5550

1144257288 BRAND MICHAEL 226 WHITE STREET DANBURY CT 06810-6814 203-702-6640

1588636807 BRANDEN PETER 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1336136183 BRANDI KAREN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1891786802 BRANDOFF DOUGLAS DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6464

1508132929 BRANSON SARAH 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

1598025892 BRASS RYAN 160 ALLEN STREET RUTLAND VT 05701-9977 802-747-1633

1730240839 BRAUER LEE 836 FARMINGTON AVENUE SUITE 229 WEST HARTFORD CT 06119-1561 860-586-8930

1841335163 BRAUER RICHARD 49 LAKE AVENUE SUITE 205 GREENWICH CT 06830-4501 203-869-0177

1467867317 BRAVO ZANCHEZ JOSE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1073552865 BRAY DIANE 664 PROSPECT AVE. HARTFORD CT 06105-4203 860-236-8087

1962031815 BREAKELL KATHERINE 94 LOCUST AVENUE DANBUYR CT 06810-5954 203-798-0500

1013946193 BRECKINRIDGE ROBERT 20 WEST AVON ROAD AVON CT 06001-3540 860-404-2745

1457610800 BREEDE-DUKETT NICOLE 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-228-7793

1609967496 BREGANTE AUDREY 148 EAST AVENUE SUITE 3G NORWALK CT 06851-5727 203-838-4034

1891878716 BREKKE MARK 269 SOUTH CANDY LANE COTTONWOOD AZ 86326-4158 800-645-3055

1437259058 BRENNAN DANIEL 52 W UNDERWOOD ST ORLANDO FL 32806-1110 800-645-3055

1538117049 BRENNAN MICHAEL 140 SHERMAN ST 2ND FLOOR FAIRFIELD CT 06824-5849 203-255-6780

1407366859 BRENNAN PATRICK 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1710029053 BRENNOCK MARGARET 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1992364301 BRESEE JAMEE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1962856179 BREW ODELIA 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-338-6600

1720182876 BRIDGER LAURIE 55 LOCK STREET YALE HEALTH NEW HAVEN CT 06511-3603 203-432-0076

1063864437 BRIGGS STEPHANY 134 THURBERS AVENUE PROVIDENCE RI 02905-0241 401-273-0641

1205217403 BRINDAMOUR LUKE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1281

1649206236 BRINDLE ALLISON 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-1000

1154677938 BRINSON WILLIAM 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1851350417 BRIONES MARIA 344 E MAIN ST STE 303 MOUNT KISCO NY 10549-3027 914-597-2317

1154375525 BRODSKY ADAM 30 SHELBURNE RD STAMFORD CT 06902-3628 203-276-7058

1649674987 BRODY ROBERT 60 LAFAYETTE ST BRIDGEPORT CT 06604-5714 203-576-4349

1164423760 BRODY SCOTT 600 ST JOHNSBURY ROAD LITTLETON NH 03561-3442 603-444-9271

1801455464 BROEMS KEVIN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1275013823 BROOKFIELD MARIAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 774-443-7552

1437265808 BROOKS JEFFREY 166 CHERRY ST NEW CANAAN CT 06840-9317 203-323-7331

1578956405 BROOKS SARAH 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 203-313-1436

1760918163 BROUSSARD JAIME 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1851498000 BROUSSEAU ERIN 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1447485172 BROWN BENJAMIN 1001 SAM PERRY BLVD. FREDERICKSBURG VA 22401-4453 800-645-3055

1689659435 BROWN CAROL 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1437318631 BROWN GABRIEL 185 ROUTE 312 CAREMOUNT MEDICAL PC BREWSTER NY 10509-2337 845-278-7000

1598994246 BROWN RYAN ONE ST. FRANCIS DR GREENVILLE SC 29601-3955 419-226-4343

1346508108 BROWN SAMUEL 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

HUSKY Health Connecticut Page 7 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 8: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1982807525 BROWN SHERI 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1639582042 BROWN STACY 20 YORK STREET YNHH NEUROLOGY NEW HAVEN CT 06510-3220 203-688-9503

1417053620 BROWN WILFRED 530 MIDDLEBURY ROAD SUITE 201A MIDDLEBURY CT 06762-2546 203-758-2564

1588624647 BROWN WILLIAM 335R PRAIRIE AVENUE SUITE 1A PROVIDENCE RI 02905-1924 401-444-5685

1649773904 BROWNSTEIN JUSTIN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1932221140 BRUNO AMY 21 E 4TH STREET NEW YORK NY 10003-7012 302-313-1584

1033296223 BRYON LORI 170 HAZARD AVE ENFIELD CT 06082-4520 860-749-2022

1760406698 BUBLY GARY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-854-2504

1578549010 BUCKBERG MIRIAM 701 ENFIELD STREET ENFIELD MA 06082-2961 860-741-6572

1134158041 BUGAI TERRENCE 1312 WEST MAIN STREET WATERBURY CT 06708-3121 215-442-5029

1275854911 BUI BENJAMIN 7600 CENTRAL AVENUE PHILADELPHIA PA 19111-2442 215-707-1429

1982679767 BUNNELL CRAIG DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-3800

1194053777 BUNNELL MAURICE 52 BEACH ROAD STE 104 FAIRFIELD CT 06824-6017 203-254-2000

1851354989 BUONANNO MARGARET 450 BROOKLINE AVE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-582-8032

1538609169 BUONOCORE PAUL 32 STRAWBERRY HILL COURT 3RD FLOOR STAMFORD CT 06902-2594 203-276-2182

1396882312 BURDICK THERESA 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1275636847 BURKARD DAVID 928 FARMINGTON AVENUE WEST HARTFORD CT 06107-1929 860-233-2322

1447353016 BURKE EMA 928 FARMINGTON AVENUE WEST HARTFORD CT 06107-1929 860-233-2322

1114171303 BURNES JILL 50 NUNNAWAUK RD NEWTOWN CT 06470-2319 203-270-2698

1245307438 BURSTEIN DAVID 34 DALE ROAD SUITE 208 AVON CT 06001-3659 860-677-0079

1811986177 BURTON JAY 701 ENFIELD STREET ENFIELD MEDICAL ASSOCIATES ENFIELD CT 06082-2961 860-741-6572

1962449900 BURTT DOUGLAS 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4102

1801987151 BUSH ERIC 780 MAIN ST., STE.1 GREAT BARRINGTON MA 01230-2180 413-528-2418

1669459178 BUTLER LAURIE 2344 BOSTON ROAD WILBRAHAM MA 01095-1104 413-596-5550

1912075706 BUZZELL STEPHEN 452 OLD STREET ROAD PETERBOROUGH NH 03458-1263 603-924-4699

1356788764 BYRON KELSEY 100 HOSPITAL ROAD LEOMINSTER MA 01453-2253 508-334-8152

1528479011 CABRAL DANIEL 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1932148814 CABRAL MARY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2930

1972851558 CADOO KAREN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-3200 646-227-3764

1205995123 CAHILL STEPHEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1285817569 CALAME ANTOANELLA 6605 NANCY RIDGE DR. SAN DIEGO CA 92121-2253 858-750-2983

1073771911 CALL THERESA 1500 N 28TH ST RICHMOND VA 23223-5332 419-226-4343

1144343328 CALLAHAN ANN 10 CORBIN DR. SUITE 4 DARIEN CT 06820-5403 203-655-0002

1205904307 CALLAHAN JOANNE 4 MIDLAND ROAD WATERBURY CT 06705-3412 203-743-4698

1659437580 CALLIS DOUGLAS 515 OLD TOLL ROAD MADISON CT 06443-1836 203-421-4100

1467459784 CALUWE PETER 736 IRVING AVENUE SYRACUSE NY 13210-1690 800-645-3055

1578788691 CAMBRE APRIL 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1366475469 CAMERON SANDRA SPRINGFIELD MEDICAL ASSOCIATES 2150 MAIN STREET SPRINGFIELD MA 01104-3300 860-741-6572

1942310040 CAMP FRANCIS 359 FARMINGTON AVENUE PLAINVILLE CT 06062-1343 860-747-5761

1770807679 CAMPBELL ANDRENE 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1669416483 CAMPBELL COLLEEN 200 WEST ARBOR DRIVE SAN DIEGO CA 92103-1911 918-203-0114

1639163314 CAMPBELL SCOTT 1111 HAYES AVE SANDUSKY OH 44870-3323 800-633-2243

1053417998 CAMPBELL GETHERS MARIAN 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-757-5339

1316288624 CAMPIS VAZQUEZ LUIS 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1265541056 CAMPO ALFONSE 111 HIGH RIDGE RD STAMFORD CT 06905-3813 203-354-3974

HUSKY Health Connecticut Page 8 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 9: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1184801458 CANDELARIA EFRAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1235334913 CANTATOREFRANCIS JULIE 148 EAST AVE. SUITE 3B NORWALK CT 06851-5726 203-538-5682

1801857149 CANTO CHRISTOPHER 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

1700264827 CAPPADONA PATRICIA 100 CENTURY DRIVE WORCESTER MA 01606-1244 508-762-5400

1679548697 CAPUANO MICHAEL 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-273-0641

1053633511 CARACANSI ANNMARIE 200 IVY STREET BROOKLINE MA 02446-3907 781-732-0253

1861592156 CARAYANNOPOULOS ALEXIOS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3777

1255821609 CARBONE CHRISTINA 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 774-443-7552

1770967549 CARDENAS CASTILLO YLEC 330 CEDAR STREET YALE NEUROLOGY NEW HAVEN CT 06510-3220 203-785-2805

1558489161 CARIUS KATHLEEN 1129 STRATFORD AVE MILFORD CT 06460-3142 203-375-8050

1699726554 CARLESI VINCENT 999 SUMMER STREET SUITE 304 STAMFORD CT 06905-5513 203-325-5700

1093119760 CARLI ALBERTO HOSPITAL FOR SPECIAL SURGERY 535 E 70 ST NEW YORK NY 10021-4823 212-774-7598

1023498052 CARMONA CARLOS 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1508812942 CARNEIRO RAQUEL 245 CHAPMAN STREET SUITE 300 PROVIDENCE RI 02905-4539 401-444-4741

1033378435 CARON DAVID 24 PUTNAM PIKE DAYVILLE CT 06241-1608 860-779-1230

1033199286 CARON PHILIP 500 WESTCHESTER AVE WEST HARRISON NY 10604-3200 646-227-3813

1730144353 CARPENTER MARSHALL 148 WEST RIVER STREET SUITE 8 PROVIDENCE RI 02904-2961 401-606-3000

1982047239 CARR JAMES 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1073580833 CARRERA MARCY 275 MOUNT CARMEL AVE HAMDEN CT 06518-1905 203-582-8742

1194144287 CARRERO DANIEL 263 FARMIGNTON AVE LM068 FARMINGTON CT 06030-1921 860-679-2730

1376557199 CARROLL CAROLYN 6 BUSINESS PARK DR. SUITE 204 BRANFORD CT 06405-2924 203-538-5682

1568557734 CARTER ARTHUR 363 HIGHLAND AVE FALL RIVER MA 02720-3703 508-973-3584

1699847178 CARTER ERIC 1900 DON WICKHAM DR CLERMONT FL 34711-1979 800-645-3055

1497158521 CARTER HEATHER 400 CAPITOL BLVD ROCKY HILL CT 06067-3913 860-986-3289

1760767925 CARTER JESSA 2 MEDICAL CENTER DRIVE SPRINGFIELD MA 01107-1270 413-794-5600

1508027244 CARTER ROBERT 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2752

1518525864 CARVALHO JAKE 759 CHESTNUT STREET SPRINGFIELD MA 01199-1619 413-794-3233

1295920239 CASEY ELLEN 535 E 70TH ST NEW YORK NY 10021-4823 212-774-7598

1336677574 CASILLO CHRISTINA 415 RIVERSIDE DRIVE N. GROSVENORDALE CT 06255-2165 860-923-1897

1679772537 CASTELLANO VINCENZO 535 E 70 ST HOSPITAL FOR SPECIAL SURGERY NEW YORK NY 10021-4823 212-774-7598

1609118421 CASTELLONE JOANN 191 ALBANY TPKE CANTON CT 06019-2554 860-693-0887

1316977242 CASTIGLIONE JR FRANK 1844 WHITNEY AVENUE HAMDEN CT 06517-1400 203-281-5445

1689891129 CASTILLO JORGE DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE, LW-210 BOSTON MA 02215-5418 617-632-6140

1265460547 CASTILLO SERGIO 1101 NOTT ST SCHENECTADY NY 12308-2425 801-256-1900

1992048789 CATALDO LAUREN 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1295965390 CATANIA SHERRY 909 HARTFORD TURNPIKE UNIT #D5 WATERFORD CT 06385-4267 860-440-0700

1346262029 CATAQUET DAVID 530 NEW BRUNSWICK AVE PERTH AMBOY NJ 08861-3654 623-241-8324

1962476218 CATTANEO COLLEEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1245209824 CAVAGE JENNIFER 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 541-510-9377

1285791244 CAVOLI ROBERT 65 MAIN ST. TERRYVILLE CT 06786-5103 860-589-9001

1073596011 CEREZO CAROLINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6779

1750563938 CERRA MARY 55 FRUIT ST BOSTON MA 02114-2696 617-643-0335

1851493852 CHA BRUCE 60 WASHINGTON AVE STE 202 HAMDEN CT 06518-3272 203-281-6574

1578080651 CHACE CATHERINE 111 SALEM TURNPIKE SUITE 7 NORWICH CT 06360-7403 860-859-2262

HUSKY Health Connecticut Page 9 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 10: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1205857117 CHACHAJ JERZY 115 SPENCER STREET WINSTED CT 06098-1141 860-738-6985

1871576736 CHALEBY KUTAIBA 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-8130

1710044847 CHAMBERLIN DOUGLAS 49 WELLES ST STE 202 GLASTONBURY CT 06033-4205 860-659-4010

1700227352 CHAMBERS CAROLYN 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1568427243 CHAN ALEXANDER 13-17 ELIZABETH STREET SUITE 510 NEW YORK NY 10013-4903 212-334-3999

1265658116 CHAN PHILIP 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-6779

1891349981 CHAN SERENA 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1710272620 CHAN SUZANNE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4741

1659790970 CHANG DANIEL 11 SOUTH ROAD STE. 250 FARMINGTON CT 06032 860-714-6654

1003158460 CHAO PA CHRISTINA 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1184032898 CHAPLIN KRISTIN 3300 MAIN STREET 3RD FL, STE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1831755461 CHAPMAN DREW 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1548571813 CHAPMAN KATIE 111 BREWSTER ST PAWTUCKET RI 02860-4474 401-273-0641

1174566806 CHAPMAN LAURA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1740542687 CHARLETON HOLLY 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1871553776 CHARNAS JEANNE 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1932312709 CHARNEY HOWARD 2559 DIXWELL AVENUE HAMDEN CT 06514-1809 203-248-0072

1235657040 CHASE CHRISTY 275 QUINNIPIAC UNIVERSITY IR-HLT HAMDEN CT 06518-1905 203-582-8738

1982825378 CHASEN JOEL 546 S BROAD STREET SUITE 3B ADVANCED ENDODONTICS OF CT PC MERIDEN CT 06450-6601 203-237-7449

1366977159 CHAU VEDA 3300 MAIN STREET 3RD FL, SUITE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1194987842 CHAUDHARY NIDA 5750 POST ROAD EAST GREENWICH RI 02818-7685 401-273-0641

1740388354 CHAVEZ SILVIO 52 W UNDERWOOD ST ORLANDO FL 32806-1110 800-645-3055

1225245228 CHEATHAM SETH 1250 EAST MARSHALL STREET RICHMOND VA 23298-5051 800-645-3055

1164681573 CHEN AMY 1 WILLOWBROOK RD SUITE 2 CROMWELL CT 06416-6230 860-322-2222

1477006120 CHEN YAN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1891021788 CHENAIL SARAH 725 NORTH STREET PITTSFIELD MA 01201-4124 413-447-2752

1598753980 CHENG CHRISTINE 555 WILLARD AVENUE NEWINGTON CT 06111-4272 203-932-5711

1376533711 CHERNYY VITALIY 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1033215256 CHERVIN BRADFORD 2600 POST ROAD SOUTHPORT CT 06890-1258 203-256-3338

1932463734 CHEUNG JENNIFER 736 BATTLEFIELD BLVD N CHESAPEAKE VA 23320-4941 800-633-2243

1215310719 CHHIKARA ADITYA 282 WASHINGTON ST HARTFORD CT 06106-3322 860-837-6277

1245215565 CHI DENNIS 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1538439484 CHILDS DENIS 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1760403224 CHIN MELISSA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1114019163 CHIRINO MARIA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1730621491 CHITEMERERE CHRISPINA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 413-313-2935

1508220179 CHITKARA RITIKA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1639454960 CHITTAMOORU SREESUBHA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1952744930 CHO YOUNGSUN 300 COLLEGE STREET YNHH - PSYCHIATRY NEW HAVEN CT 06511-6624 203-785-2095

1881959229 CHOCKALINGAM RAVIKUMAR 189 STORRS ROAD MANSFIELD CT 06250-1683 860-456-1311

1740440262 CHOI BRYAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1780091660 CHOI SUN-JUNG 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1669577953 CHOMIAK MARY ANN 5520 PARK AVENUE STE. WP2-200 TRUMBULL CT 06611-3463 203-743-7246

HUSKY Health Connecticut Page 10 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 11: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1245227016 CHON YEONG 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1710454137 CHOU SARAH 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1184061400 CHOW ERIC 593 EDDY STREET 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1922136886 CHRISTIAN LAWRENCE 625 HOPMEADOW STREET SIMSBURY CT 06070-2449 860-658-1991

1508266750 CHRISTIAN MICHAEL 625 HOPMEADOW ST CENTER FOR DENTAL EXCELLENCE SIMSBURY CT 06070-2449 860-658-1991

1770810319 CHU JEFFREY 1060 DAY HILL ROAD WINDSOR CT 06095-5719 860-688-5595

1326338559 CHUKWUEKE UGONMA 450 BROOKLINE AVE, BOSTON MA 02215-5450 617-632-2166

1811911753 CHUN THOMAS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1568635530 CHUNG DAVID 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1700044468 CHUNG ERICA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-7396

1518992874 CHUNG JIN 555 WILLARD AVENUE NEWINGTON CT 06111-2631 203-932-5711

1992723282 CIANCIMINO DAVID 4 CORPORATE DRIVE SUITE 382 SHELTON CT 06484-6211 203-372-5695

1740390228 CIARALLO LYDIA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1649428319 CIARCIA JAMES 388 EAST MAIN ST SUITE 3 BRANFORD CT 06405-2914 203-483-5300

1710211370 CICHON ZIMKUS DEANNA 464 WOLCOTT ROAD NUMBER 3 WOLCOTT CT 06716-2626 203-433-5227

1063473312 CIMINO PETER 1300 POST RD SUITE 202 FAIRFIELD CT 06824-6038 203-255-8827

1801842505 CIMINO WILLIAM 52 BEACH RD STE 207 FAIRFIELD CT 06824-6017 203-255-7000

1720020597 CIOFFI PATRICIA 555 WILLARD AVENUE NEWINGTON CT 06111-2600 860-666-6951

1063436418 CIONNI DAVID 1024 CENTRAL PARK DR STEAMBOAT SPRINGS CO 80487-8813 800-645-3055

1033200506 CLARK ANDREW 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-7089

1326387846 CLARK ANN MARIE 91 WATER STREET MILFORD MA 01757-3005 508-334-8152

1124098876 CLARK HELEN 725 NORTH STREET PITTSFIELD MA 01201-4109 413-447-2752

1275923781 CLARK JONATHAN 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1770517260 CLARK PETER 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1831132406 CLARK TIFFANY 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1457575052 CLAUSS KELLY 55 PECK ROAD TORRINGTON CT 06790-6106 860-482-8588

1952713620 CLAYTON JEROME 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1083153969 CLIFFORD MATTHEW 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1083638928 CLYNE BRIAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1962405100 COCHRAN ELAINE 9000 ROCKVILLE PIKE BUILDING 10, CRC 6-5940 BETHESDA MD 20892-1612 301-496-2718

1437310182 COCOLA ELIZABETH 131 GAIL LANE SOUTH WINDSOR CT 06074-4224 860-282-9457

1679557276 CODY III HIRAM 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1932121365 COE MARY 72 NORTH STE 103 DANBURY CT 06810-5627 203-748-1200

1942231782 COFFEY TOM 15 CORPORATE DRIVE TRUMBULL CT 06611-1351 203-452-7081

1972584779 COFFMAN CHARLES 1200 N BEAVER STREET FLAGSTAFF AZ 86001-3118 800-645-3055

1447350319 COGGUILLO CHRISTOPHER 203 CHERRY STREET MILFORD CT 06460-3501 203-874-0000

1104172931 COGHLAN MEGAN 736 IRVING AVENUE SYRACUSE NY 13210-1690 800-645-3055

1942237847 COGHLIN DANIEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1033294269 COHEN KENNETH 22 UPPER MAIN STREET BOX 634 SHARON CT 06069-0634 917-597-7890

1962604785 COHN JAMIESON 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1740271444 COIT DANIEL 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1073789830 COLAN MIGUEL 330 MAIN STREET 2ND FLOOR HARTFORD CT 06106-1880 860-241-0448

1780043539 COLEMAN MAIREAD 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1821095431 COLEMAN MARK 67 SANDPIT RD. STE. 308 DANBURY CT 06810-4032 410-329-1071

1205062205 COLICCI-FAVRETTO NATALIE 2 CORPORTATE DRIVE, UNIT 112 TRUMBULL CT 06611-3563 203-371-1021

HUSKY Health Connecticut Page 11 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 12: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1649620501 COLLERAN PETER 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1538184759 COLLINS BRADLEY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1275001893 COLLINS MEGAN 55 LAKE AVENUE NORTH WOCESTER MA 01655-0002 508-793-6348

1790888584 COLLINS SIOBHAN 499 FARMINGTON AVE SUITE 230 FARMINGTON CT 06032-1933 860-676-1900

1497099519 COLON ROMAN WANDA 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1285650622 COLWELL SHARON 1450 CHAPEL ST NEW HAVEN CT 06511-4405 203-789-3000

1174585723 CONCILIO GERARDO 132 OLD RIVER RD LINCOLN RI 02865-1397 401-334-2949

1023113818 CONDON DEIDRE 172 MT. PLEASANT RD. NEWTOWN CT 06470-1443 203-426-0045

1104379783 CONLAN BRAEDEN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1295766194 CONLEY LAURENCE 951 N. WASHINGTON AVE TITUSVILLE FL 32796-2163 800-645-3055

1134194087 CONNER DAVID 506 6TH STREET NY PRESBYTERIAN BROOKLYN METHO BROOKLYN NY 11215-3609 516-326-0808

1346649019 CONNOR JACQUELINE 2150 MAIN STREET SPRINGFIELD MA 01104-3566 860-741-6572

1871668186 CONRAD CYNTHIA PSYCH CONSULT & SPEC SVC, LLC 9 WINGATE ROAD GUILFORD CT 06437-5501 203-499-7096

1265434526 CONSTANTINOU EUGENE 555 WILLARD AVE NEWINGTON CT 06111-2631 860-666-6951

1720372196 CONWAY ERIN 223 E 34TH ST NEW YORK NY 10016-4852 646-558-0803

1316419732 COOKE EMMA 1817 BLACK ROCK TPKE STE 205 FAIRFIELD CT 06825-3546 914-227-2088

1639275662 COOKE ROBERT 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1255792479 COOPER DANIELL 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-221-0791

1881022879 COORE MAXINE 950 CAMPBELL AVE WEST HAVEN CT 06516-1233 203-798-8422

1548371800 COPANS STUART 455 SOUTH STREET BARRE MA 01005-0304 978-355-4541

1396706230 COPE JENNIFER 1200 EAST RIDGEWOOD AVE SUITE 208 RIDGEWOOD NJ 07450-3957 201-444-0868

1598763997 COPPOLA PAUL 145 DURHAM RD. STE 1 OAK PARK PROF.OFFICES MADISON CT 06443-2656 203-245-8035

1639105810 CORCORAN CELESTE 593 EDDY STREET HASBRO LOWER LEVEL PROVIDENCE RI 02903-4923 401-444-8984

1023409323 CORCORAN GREGORY 100 CAPITAL WAY PENNINGTON NJ 08534-2520 215-442-5084

1619967114 CORDES DAVID 145 HAZARD AVE ENFIELD CT 06082-4521 860-749-1909

1982984316 COREY JORDICE 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661-8973 508-482-9600

1083083638 CORNELL KIMBERLY 71 WALL STREET ARIA DERMSPA MADISON CT 06443-3121 203-865-6143

1720173099 CORRIVEAU JENNIFER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1407015944 CORSELLO STEVEN 450 BROOKLINE AVE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-4500

1891740189 COSTEA GEANINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4515

1174714117 COVEY CINTHIA 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1699909218 COX CAROLINE 180 FLOYD AVENUE ROCKY MOUNT VA 24151-1318 800-645-3055

1063937720 COYLE KAITLIN 435 LEWIS AVE. MERIDEN CT 06451-2101 203-710-5419

1972866622 CRAFORD JOHN PAUL 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1629039847 CRAFTON CHARLES 1330 TAYLOR AT MARION STREETS COLUMBIA SC 29203-6863 888-851-7590

1104086925 CRAGO AIMEE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1841467503 CRAIG ELIZABETH 5 DURHAM ROAD UNIT 1-4 GUILFORD CT 06437-2076 203-458-4444

1023038460 CRICHTON REBECCA 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1225036528 CRISCENZO DONNA 199 GOOSE LANE GUILFORD CT 06437-2115 203-458-2888

1568606960 CRISTESCU GEORGE 455 TOLL GATE RD JOHNSON BUILDING WARWICK RI 02886-2791 401-273-0641

1336596998 CRISTOFANO PAUL 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1578001426 CROWLEY JUSTIN 3000 ARLINGTON AVE TOLEDO OH 43614-2595 419-383-4025

1790816676 CRUEA STEVEN 1333 TAYLOR STREET COLUMBIA SC 29202-2266 803-296-7998

HUSKY Health Connecticut Page 12 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 13: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1194793794 CRUMP MICHAEL 2720 SUNSET BLVD WEST COLUMBIA SC 29169-4810 888-851-7590

1346521531 CRUZ AVILES LISA 20 YORK STREET YNHH PEDIATRIC ENDOCRINOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1467656330 CUCCHI ERIC 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 508-797-5512

1669429130 CUCULINO GREGORY 951 N. WASHINGTON AVE TITUSVILLE FL 32796-2163 800-645-3055

1457393738 CUDNIK MICHAEL 636 DEL PRADO BLVD CAPE CORAL FL 33990-2695 800-645-3055

1295954469 CUEVAS PABLO 111 BEACH RD S 2ND FLOOR FAIRFIELD CT 06824-6668 203-254-0545

1538197066 CULLEN MICHAEL 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1437548997 CUMMINS ANDREW 8 LINCOLN ST. WESTPORT CT 06880-4201 203-916-4600

1174799944 CUNNINGHAM ANDREW 21 E 4TH STREET NEW YORK NY 10003-7012 302-313-1584

1457803298 CUNNINGHAM LINDA 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1134321722 CUNNINGHAM MATTHEW 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1366728693 CURATO MARK 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1568698009 CURESKY KIMBERLY 1881 POST RD FAIRFIELD CT 06824-5721 203-255-1036

1831413806 CURLEY DAVID 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1033111356 CURRAN DONALD 950 CAMPBELL AVE WEST HAVEN CT 06516-2770 203-932-5711

1982725032 CURRAN KEVIN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3754

1154610590 CURRIER MICHAEL 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1518903293 CURRY CRAIG 7 GERMANTOWN RD DANBURY CT 06810-5000 203-798-8422

1952565889 CURTICE WALTER 116 GRANITE STREET QUALITY MEDICINE LLC WESTERLY RI 02891-2460 401-602-7031

1457519829 CUSHING SEAN 10123 SE MARKET PORTLAND OR 97216-2532 800-633-2243

1588637938 CUSHNER FRED 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1992964548 CUTTING SHAWNA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1982819058 CWIK RONALD 652 BOSTON POST ROAD GUILFORD CT 06437-2719 203-453-5214

1366674574 CYRIL GEORGE 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1972746345 CZAPLA LAUREN 450 BROOKLINE AVE BOSTON MA 02215-5405 617-632-3800

1801882337 D ANGELO JOHN 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1023420247 DAGOSTINO MARISA 1300 MASSACHUSETTS AVE TROY NY 12180-1695 800-645-3055

1851707723 DAHAL RABIN 20 YORK ST FITKIN 615 NEW HAVEN CT 06510-3220 203-688-9503

1770591307 DAHLBERG CARL 725 NORTH STREET PITTSFIELD MA 01201-4109 413-447-2752

1679699136 DAHLGARD KAREN 832 TALL TIMBER RD ORANGE CT 06477-1424 203-387-8425

1639144843 DAHLSTROM GERALD 119 BELMONT STREET WORCESTER MA 01605-2903 508-334-8152

1053372862 DAHLSTROM RUTH 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1548647183 DAILEY JOELYNN 263 FARMINGTON AVE LM068 FARMINGTON CT 06030-1921 860-679-4763

1215916697 DALBAGNI GUIDO 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1386892321 DALRYMPLE NANCY HJDC 920 BROAD ST HARTFORD CT 06106-2402 860-291-9692

1891755211 DALUISKI AARON 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1053489864 DAMAN LAUREN 100 RETREAT AVE SUITE 603 HARTFORD CT 06106-2528 860-246-3533

1407869654 DAMIAN CHRISTINE 201 14TH ST. SW LARGO FL 33770-3133 888-851-7590

1265879555 DAMRONGWATANASUK RONGRAS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1861422982 DANG CHAU 500 WESTCHESTER AVE MSK HARRISON WEST HARRISON NY 10604-3200 646-227-3742

1124405113 DANIAL WILLIAM 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1760642698 DANIELS ALAN 593 EDDY STR RHODE ISLAND HOSPITAL PROVIDENCE RI 02903-4923 401-490-1939

1528401304 DANIELS-MILLER LINDA 36 EAST MAIN STREET AVON CT 06001-3801 860-677-5533

HUSKY Health Connecticut Page 13 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 14: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1891752002 DANOSI STEVE 16 HOSPITAL ROAD PLYMOUTH NH 03264-1126 603-238-6467

1760518724 DANZIGER HENRY 297 CHURCH ST DENTAL OFFICE NAUGATUCK CT 06770-3629 203-729-0563

1346506094 DAO NHU Y 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1053399105 DAPAAH-AFRIYIE KWAME 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1811158264 DARAS MARIZA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3742

1053764993 DARKOH ERNEST 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1356990568 DARNELL CAREY 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-6297

1386717783 DARVISH AMIR 800 WASHINGTON STREET BOSTON MA 02111-1552 617-636-4721

1962425009 DASCANIO JOSEPH 532 CHAPEL STREET NEW HAVEN CT 06511-6905 203-865-4286

1952714461 DATTA RUPAK 800 HOWARD AVENUE YNHH INFECTIOUS DISEASES NEW HAVEN CT 06519-1369 203-785-7571

1013432582 DAVIAU DUNCAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1659541522 DAVIDS MATTHEW DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6140

1861854127 DAVIDSON MARA 8 LINCOLN STREET WESTPORT CT 06880-4201 203-916-4600

1396874723 DAVIES JEFFREY 340 BROAD ST SUITE 205 TOTAL MEDICAL CARE WINDSOR CT 06095-3030 860-688-8888

1487621199 DAVIES KIMBERLY 450 BROOKLINE AVE BOSTON MA 02215-5405 617-632-4998

1386603967 DAVIES MONIKA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1376958504 DAVILA MIGUEL 7171 N. DALE MABRY HWY TAMPA FL 33614-2665 800-645-3055

1710114830 DAVIS DONNA 335 BILTON ROAD SOMERS CT 06071-1044 860-538-2153

1497005011 DAVIS KRYSTAL 20 YORK STREET NEW HAVEN CT 06510-1111 203-688-2430

1710544861 DAVIS SHADAY 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-685-8771

1700818879 DAVISON JAMES 200 STONECREST BLVD., SUITE 15 SMYRNA TN 37167-6810 727-507-3606

1104261262 DAWSON ADAM 3269 STOCKTON MEDICAL CENTER KINGMAN AZ 86409-3619 928-757-0625

1033591532 DAWSON CATHERINE 20 YORK STREET YNHH GERIATRICS NEW HAVEN CT 06510-3220 203-688-9423

1619140316 DAYE MONA NATCHAUG HOSPITAL 189 STORRS RD MANSFIELD CENTER CT 06250-1683 860-456-1311

1710398235 DE AQUINO LIMA JOAO PAULO 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6664 203-785-2095

1104109305 DE LARA KRISTOFFER 11 SOUTH ROAD STE. 250 FARMINGTON CT 06032-2484 860-674-0222

1053676627 DE SOUZA ANDREA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2920

1750669685 DECHON REBEKAH 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1831149780 DEFOREST KELLY 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-748-8484

1609289008 DEFRODA STEVEN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1306913785 DEITZ JEFFREY 1261 POST ROAD SUITE 200-A FAIRFIELD CT 06824-6072 203-255-0770

1275853897 DELACALZADA JEANLOUIE MAE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1093867913 DELFINI RONALD 1204 CHAPEL ST. NEW HAVEN CT 06511-4777 203-787-4770

1396874921 DELIYANNIDES DEBORAH 30 OLD KING''S HIGHWAY SOUTH DARIEN CT 06820-0820 203-655-7657

1154785715 DELMONTE ANTHONY 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06512-6663 203-785-2095

1619990868 DELVECCHIO JOHN 500 W. PUTNAM AVE SUITE 400 GREENWICH CT 06830-6096 203-274-2870

1033223219 DELVECCHIO RONALD 281 HARTFORD TPKE VERNON CT 06066-4784 860-872-6016

1588631964 DEMAC ALEX 530 MIDDLEBURY ROAD SUITE 202-B MIDDLEBURY CT 06762-2500 203-758-1817

1043752538 DEMACEDO SHERRY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1841267093 DEMETRI GEORGE DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-5917

1467472217 DEMINO TRACEY 206 SECOND STREET EAST BRADENTON FL 34208-1042 941-745-7400

1760405542 DEMPSEY THOMAS 163 BROADWAY ST COLCHESTER CT 06415-1022 860-228-1719

1508139221 DENSLEY LINDSEY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-7334

1073912614 DEPINTO CASSANDRA 1275 SUMMER STREET SUITE 306 STAMFORD CT 06905-5359 203-978-5775

1467083402 DERRICOTTE ELLIOT 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-6297

HUSKY Health Connecticut Page 14 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 15: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1124318381 DESAI AVANI 1250 E MARSHALL ST RICHMOND VA 23298-5051 800-645-3055

1124122148 DESAI UDAY 1275 SUMMER STREET,SUITE 102 STAMFORD CT 06905-5315 203-325-0764

1013462332 DESERRES DANIELLE 3300 MAIN STREET SPRINGFIELD MA 01107-1112 413-794-5600

1154617686 DESESA CHRISTOPHER 115 ELM STREET ENFIELD CT 06082-3712 413-788-9621

1316309503 DESOUZA FLAVIA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1043214604 DESPOT KATY 115 TECHNOLOGY DR, A100 TRUMBULL CT 06611-5343 203-880-5556

1902069602 DESSENT JOSEPH 200 KENNEDY MEMORIAL DRIVE WATERVILLE ME 04901-4526 800-645-3055

1821270703 DEVIKA GAJRIA 300 E. 66TH ST NEW YORK NY 10065-6800 646-888-4526

1679581623 DEVINSKY ORRIN 223 EAST 34TH ST NEW YORK NY 10016-4852 646-558-0859

1427360999 DEVIVO RYAN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1962751396 DEVKOTA ASHOK 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1144262403 DEVLI AYNUR 65 JAMES STREET EDISON NJ 08820-3947 800-645-3055

1780164244 DEXHEIMER CHELSEA 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1316237555 DHARIA NEEKESH 450 BROOKLINE AVENUE BOSTON MA 02215-5418 508-482-9600

1245645035 DHILLON SAUD 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3985

1235541277 DHOND MUKTA 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 203-687-3453

1528339934 DHROSO KAYLN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1831538016 DIAZ BALZAC ROBERTO 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1932292893 DIB DONALD 839A RIVER RD SHELTON CT 06484-5433 203-929-1005

1477945368 DIBARA COLLEEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1154895704 DIBIASE TRISHA 187 SOUTH CANAAN ROAD CANAAN CT 06018-2544 860-824-1397

1649627811 DIBIASIO-WHITE ERIC 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5550

1801877915 DICKSTEIN ROSS 67 SANDPIT RD. STE. 308 DANBURY CT 06810-4032 410-329-1071

1356330344 DIEDERICH JENNIFER 218 MAIN STREET FARMINGTON CT 06032-2959 860-470-3660

1386624138 DIGANGI MARY 326 NICHOLAS ROAD FITCHBURG MA 01420-1914 508-334-6556

1811056054 DIKE CHARLES BOX 351 - 1000 SILVER STREET CONNECTICUT VALLEY MIDDLETOWN CT 06457-7023 860-418-6918

1871861625 DILLON RYAN 420 EAST MAIN STREET SUITE #5 BRANFORD CT 06405-2941 203-433-2550

1710962709 DISA JOSEPH 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1790126480 DISTEFANO JESSICA 55 LAKE AVENUE NORTH WORCESTER MA 01605-0002 508-334-8152

1871684142 DITRO COLLEEN 1600 ROCKLAND ROAD WILMINGTON DE 19803-3607 302-651-4548

1477083996 DIVANNO JESSICA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1467826511 DIXON ANNIKA 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1578750808 DIXON PETER 192 WESTBROOK RD. ESSEX CT 06426-1556 860-767-1200

1194787028 DIXSON MILADY 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1245490036 DLUGOKINSKI-PLENZ SYLVIA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 716-983-1283

1235304429 DO KHANH DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-3332

1831176445 DOBERSTEIN CURTIS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9166

1134665383 DOBERSTEIN LINDA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1700195807 DOCCHIO MICHAEL 6 DAVIS ROAD WEST OLD LYME CT 06371-2323 860-434-5565

1952383960 DOCTOROFF LAUREN 330 BROOKLINE AVE BOSTON MA 02215-5400 617-754-4677

1962494054 DOHERTY KAREN 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1740533439 DOHERTY LAURA 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1497700652 DOHERTY LISA DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5450 617-632-5925

HUSKY Health Connecticut Page 15 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 16: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1093808883 DOLAN THOMAS 1160 SILAS DEANE HIGHWAY SUITE 103 WETHERSFIELD CT 06109-4330 860-529-2000

1053578476 DOMINGO EMILISSA 455 TOLLGATE RD WARWICK RI 02886-2759 401-921-7566

1982729174 DOMMU VERNON 198 PRATT STREET FAIRFIELD CT 06824-6484 203-336-1275

1619196755 DONALDSON DAVID 593 EDDY STREET PROVIDENCE RI 02903-4923 401-464-9751

1417042672 DONATO-DUQUE WELDA 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-7089

1447891619 DONLON RILEY 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1649218223 DONOFRIO LISA 134 PARK STREET NEW HAVEN CT 06511-5409 203-865-6143

1134194046 DONOVAN LESLIE 159 WEST PUTNAM AVENUE GREENWICH CT 06830-5329 203-869-7080

1962990291 DOODY CAITLIN 944 DANBURY ROAD WILTON CT 06897-0409 203-544-0005

1396723151 DORAN DOUGLAS 14 EAST HAMPTON ROAD MARLBOROUGH CT 06447-1467 860-295-9536

1871575936 DORFMAN DAVID 1 BOSTON MEDICAL CENTER PLACE BOSTON MA 02118-2335 617-414-5405

1558756395 DOROS JOSHUA 6655 ALVARADO ROAD SAN DEIGO CA 92120-5208 918-203-0114

1053405043 DORSEY MICHAEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1245639871 DOS SANTOS ROBYN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1689122129 DOUGLAS SEAN 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2726

1033443692 DOUGLAS MATTY HOLLY 23 WAUREGAN RD BROOKLYN CT 06234-1924 860-774-0876

1699182535 DOWELL ERICA 223 E 34TH ST NEW YORK NY 10016-4852 646-501-3224

1457645269 DOWNS JAIRON 3643 N ROXBORO ROAD DURHAM NC 27704-2702 919-620-4855

1437267465 DOYLE MICHAEL 4920 MAIN STREET SUITE 301 BRIDGEPORT CT 06606-1300 203-373-1200

1881860310 DOYLE MICHAEL 6 THORNDAL CIR 102 DARIEN CT 06820-5014 203-324-4747

1215993506 DOYLE THOMAS 11 FRIENDSHIP STREET LIFESPAN PHYSICIANS GROUP, INC NEWPORT RI 02840-0000 401-845-1281

1891132924 DRAKE JONATHAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6440

1760617559 DREHER REBECCA 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1205912235 DREISBACH VICTORIA 1000 SILVER STREET MIDDLETOWN CT 06457-7023 860-262-5000

1629043625 DRENNAN PETER 701 ENFIELD STREET 701 ENFIELD STREET ENFIELD CT 06082-2961 186-074-1605

1811028731 DREW JOHN 256 BOSTON POST ROAD WATERFORD CT 06385-2054 860-443-0861

1558532747 DREW SHANNON 291 WHITNEY AVE SUITE 303 NEW HAVEN CT 06511-3724 203-624-0570

1578876876 DRILON ALEXANDER 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1295826147 DROST PAUL 950 CAMPBELL AVE WEST HAVEN CT 06516-2770 203-932-5711

1457779365 DROZDOWICZ LINDA YALE CHILD STUDY CENTER 230 S FRONTAGE RD NEW HAVEN CT 06519-1124 203-737-7129

1154417293 DRUGGE RHETT 50 GLENBROOK ROAD UNIT 1C STAMFORD CT 06902-2914 203-324-5719

1538130786 DRUMMOND BRIAN 2800 E. AJO WAY TUCSON AZ 85713-6204 801-256-1900

1063545051 DRYSGULA JR EDWARD 775 WASHINGTON STREET MIDDLETOWN CT 06457-2903 860-347-6100

1821172073 DSOUZA DEEPAK 950 CAMPBELL AVENUE PSYCHIATRY SERVICE 116A, VACHS WEST HAVEN CT 06516-1111 203-932-5711

1720095433 DUDAS BRITTANY 270 GREENWICH AVENUE GREENWICH CT 06830-6520 917-674-2545

1508006750 DUDLEY CATHERINE 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1275035388 DUFFANY BROOKE 1 BLACHLEY ROAD STAMFORD CT 06902-0001 212-774-7598

1326087677 DUFFY CHRISTINE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-7272

1578533923 DUFFY DONNA 361 MAIN STREET MANCHESTER CT 06040-4127 860-646-9929

1912905621 DUFFY JR MD PATRICK 166 WATERBURY ROAD, SUITE 301 PROSPECT CT 06712-1246 203-758-3163

1346603206 DUKE CHARLES 20 YORK STREET YNHH EMERGENCY DEPARTMENT NEW HAVEN CT 06510-3220 203-688-4242

1568617918 DUNKLE LISA 12 RICHBOROUGH ROAD MADISON CT 06443-2530 203-599-6064

1598923948 DUNN PETER 308 E 73RD ST NEW YORK NY 10021-4433 212-517-3954

1457649063 DURAZZO TYLER 4 CORPORATE DR. SUITE 386 SHELTON CT 06484-6211 203-538-5682

HUSKY Health Connecticut Page 16 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 17: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1104892595 DURFEE MARK 43 HIGH STREET WAREHAM MA 02571-2097 508-482-9600

1033163209 DURKIN DEBORA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1407013147 DUVAL EDWARD 26 DORRANCE ST DANIELSON CT 06239-3609 860-774-7544

1649291980 DWENGER RANDALL 3 BROOK STREET BOX 718 LAKEVILLE CT 06039-0718 860-435-8863

1407165780 DWIRA KOBINA 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1770582876 DYER CANDACE 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-921-7362

1013154509 EATON MAURITA 2876 MAIN STREET STRATFORD CT 06614-4984 203-696-6125

1992191969 EBERLY PULEO ASHLEIGH 450 BROOKLINE AVE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5055

1174500052 ECHANIQUE CAMILO 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 203-932-5711

1083663058 ECKENRODE DELORETTA 67 SANDPIT ROAD SUITE 308 DANBURY CT 06810-4032 203-743-7246

1063583466 EDDY BRIAN 1224 FARMINGTON AVE WEST HARTFORD CT 06107-2668 860-313-0947

1396377545 EDDY MICHAEL 2 MEDICAL CENTER DRIVE SUITE 308 SPRINGFIELD MA 01107-1270 413-794-7020

1902956121 EDELMANN CHRISTOPHER 42 SHERWOOD PL GREENWICH CT 06830-5638 203-869-0502

1215943147 EDENS ELLEN 950 CAMPBELL AVE. WEST HAVEN CT 06516-2770 203-932-5711

1689638751 EDWARDS CHRISTINE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1013973486 EDWARDS MARILEE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1518042092 EGAN KENNETH 901 ETHAN ALLEN HWY RIDGEFIELD CT 06877-2834 203-438-4111

1073874509 EGAN PAMELA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1619234341 EGOLF AMY 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1205898806 EGSIEKER ERIK 10123 SE MARKET PORTLAND OR 97216-2532 800-633-2243

1376925545 EIDMAN DANIEL 20 YORK ST YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1215363114 EIDT PEARSON LAUREN 151 WORCESTER ROAD BARRE MA 01005-9002 508-334-6556

1477591097 EIN ALSHAEBA SAMER 95 SCOVILL ST VA CLINIC, SECOND FLOOR WATERBURY CT 06706-1113 203-465-5292

1134210289 EINBINDER ROSLYN 60 TEMPLE STREET SUITE 4E NEW HAVEN CT 06510-2716 203-562-4088

1316424625 EKOKOTU ENOH 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1235201856 EL TAMER MAHMOUD 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1952308827 EL-MOHANDES ALI 67 SANDPIT RD. STE. 308 DANBURY CT 06810-4032 410-329-1071

1700836012 ELDERKIN JAMES BRIDGEPORT CORRECTIONAL CENTER 1106 NORTH AVENUE BRIDGEPORT CT 06604-2710 475-225-8071

1912136086 ELHAMAMSY SALAHELDIN 455 TOLL GATE ROAD WARWICK RI 02886-1417 401-273-0641

1194072744 ELIA MILAGROS 999 SUMMER STREET, SUITE 304 STAMFORD CT 06905-5513 203-325-5700

1063477032 ELINZANO HEINRICH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1639333834 ELLIOT ADRIAN 29 LEWIS AVE GREAT BARRINGTON MA 01230-1713 413-881-5427

1336359587 ELLIS SCOTT 535 EAST 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1336611656 ENGEL MICAH 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1568522159 ERIC GLADSTEIN D/B/A GLAD STEIN DENTAL 70 VINE STREET NEW BRITAIN CT 06052-1431 860-223-1162

1083769921 ERWICH LAWRENCE 420 S. MAIN ST. CHESHIRE CT 06410-2308 203-272-7044

1609142934 ESCHRICHT EMMA 5 PERRYRIDGE RD GREENWICH HOSPITAL GREENWICH CT 06830-4608 203-863-3000

1083093256 ESIOBU NKEMKA 34 PARK STREET NEW HAVEN CT 06519-1109 203-974-7072

1992110423 ESTES FORREST 5353 REYNOLDS ST SAVANNAH GA 31405-6015 800-645-3055

1831572239 ESTIS NICHOLAS 1 HOSPITAL PLAZA STAMFORD HOSPITAL STAMFORD CT 06902-3602 646-797-8471

1821311697 ESTRADA MARIA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1336584457 ESTRELLADO MARK 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1487740650 EVANS BRIAN 60 WASHINGTON AVENUE SUITE 207 HAMDEN CT 06518-2601 203-288-5916

HUSKY Health Connecticut Page 17 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 18: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1902895402 EVANS MICHAEL 200 ZACHARY ROAD MANCHESTER NH 03109-5607 603-621-3516

1467948349 EVANS MONICA 759 CHESTNUT STREET W2810 SPRINGFIELD MA 01107-1619 413-794-5370

1447570122 EVANS TARRA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5943

1821225558 EVENCHIK BENJAMIN 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2752

1932164886 FAGIN JAMES 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1710952064 FAGUNDES LINDA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1417062357 FALES ROBERT 85 CHURCH ST MIDDLETOWN CT 06457-3647 860-344-8606

1063722353 FALK JOY 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-346-4133

1902905185 FALK KATHERINE 115 E 92 STREET NEW YORK NY 10128-1688 212-860-5370

1346312717 FALKENBERRY STEPHEN 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1083910830 FAN LIQI 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1134354483 FAN WEI 1 BROOKDALE PLZ BROOKLYN NY 11212-3139 800-645-3055

1770601528 FANJOY HOLLY 200 KENNEDY MEMORIAL DRIVE WATERVILLE ME 04901-4526 800-645-3055

1952759524 FARAMARZI NEGAR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1649481615 FARBER GREGORY 1060 DAY HILL ROAD WINDSOR CT 06095-5719 860-688-5595

1215025986 FARBER JOSHUA 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 203-932-5711

1720165699 FAROOKI AZEEZ 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1215130034 FEDEN JEFFREY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1144307414 FEINBERG DENNIS 2875 MAIN STREET STRATFORD CT 06614-4979 203-375-3411

1326019647 FEINSTEIN MARC 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1720050313 FEIT LLOYD 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1184647802 FELDMAN AILEEN 51 NORTH MAIN ST SUITE 1A SOUTHINGTON CT 06489-2515 860-628-9121

1649210170 FELDMAN STEVEN 1090 NEW LONDON AVE CRANSTON RI 02920-3035 617-645-0840

1649249715 FELIBRICO OLIVER 1945 STATE ROUTE 33 NEPTUNE NJ 07753-4859 800-645-3055

1649458290 FELIS DAVIES MARY JO 140 SHERMAN STREET 2ND FLOOR FAIRFIELD CT 06824-5849 203-255-2403

1316168180 FERGUSON DAYNA 452 OLD STREET ROAD PETERBOROUGH NH 03458-1263 603-924-4699

1164837936 FERNANDES DENISE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1942213061 FICKETT DAVID 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

1174525125 FIELDING KRISTIN 50 MEMORIAL BOULEVARD NEWPORT RI 02840-3636 401-606-4510

1467589580 FIGUEROA AWILDA 183 BOSTON POST RD WEST HAVEN CT 06516-2026 203-877-0112

1972713535 FILBERT ELIZABETH 1389 WEST MAIN ST SUITE 208 WATERBURY CT 06708-3115 203-757-1287

1356855142 FILLMORE MELISSA 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1831159367 FILOR CAROLINE 159 WEST PUTNAM AVENUE GREENWICH CT 06830-5329 203-869-7080

1437310869 FINCH JUSTIN UCONN MEDICAL GROUP 21 SOUTH ROAD FARMINGTON CT 06032-0001 860-679-3692

1477840973 FINLAN LINA 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1932361698 FINN ARKADIY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1164501763 FINNEGAN SARAH 555 WILLARD AVENUE NEWINGTON CT 06111-2631 860-666-6951

1265692149 FINNEGAN DMD RYAN 134 MONTOWESE STREET BRANFORD DENTAL CARE BRANFORD CT 06405-3481 203-488-7444

1629295001 FIRTH JACQUELINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1770671224 FISCHBEIN ELLEN 355 HIGHLAND AVE SUITE 101 CHESHIRE CT 06410-2551 203-272-1208

1467613224 FISCHER DAISY 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2726

1770502262 FISH STEPHANIE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1932100666 FISH THOMAS 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1427092329 FITZGERALD GEOFFREY 250 PLEASANT STREET EMERGENCY DEPT CONCORD NH 03301-7539 951-430-1497

1760444145 FITZPATRICK TIMOTHY 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

HUSKY Health Connecticut Page 18 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 19: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1306839485 FITZSIMMONS LAURA PAMELA ROBUSTELLO 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1730158957 FLAMMER MARK 3460 SOUTH PIONEER PARKWAY WEST VALLEY CITY UT 84120-2049 385-695-1914

1679845648 FLANAGAN MAUREEN 51 TOMS ROAD STAMFORD CT 06906-2152 203-977-4977

1629048616 FLANIGAN ALAN 100 MCGREGOR STREET MANCHESTER NH 03102-3730 603-580-6539

1063988632 FLAVIN KERIANNE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1699076927 FLEMING JENNIE 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-6206

1245264316 FLESHER RYAN 1924 ALCOA HWY KNOXVILLE TN 37920-1511 800-645-3055

1992230924 FLOOD COLIN 464 CONGRESS AVE YNHH EMERGENCY DEPT NEW HAVEN CT 06519-1361 203-737-2644

1205106382 FLORES JOSE 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1457758708 FLORES JUAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1336382787 FLORY JAMES 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1912063181 FLYNN CHERYL 2 WAKE ROBIN RD SUITE 202 LINCOLN RI 02865-4241 401-333-1656

1114031390 FLYNN JACQUELINE 223 MEADOW ST SUITE #3 NAUGATUCK CT 06770-9994 203-723-5715

1134172265 FLYNN JENNIFER THE LOOMIS CHAFFEE SCHOOL 4 BACHELDER RD WINDSOR CT 06095-0705 860-687-6325

1891243861 FLYNN JOSEPH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9167

1992767354 FLYNN RICHARD 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1962503854 FOLLETT JULIE 1268 MAIN ST SUITE 101 NEWINGTON CT 06111-3038 860-665-0039

1427025105 FOMITCHEV OLEG 350 BOULEVARD PASSAIC NJ 07055-2840 918-203-0114

1093120263 FONDELL ANDREW 282 WASHINGTON ST HARTFORD CT 06106-3322 860-545-5000

1689635344 FORCIER MICHELLE 593 EDDY ST PROVIDENCE RI 02903-4923 401-444-6195

1083648125 FOREST LEE 2184 MAIN STREET STRATFORD CT 06615-5937 203-378-9002

1972592822 FORTIER LAWRENCE 465 SILAS DEANE HIGHWAY WETHERSFIELD CT 06109-2134 860-529-2500

1326012345 FORTIER NATASHA 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-8515

1396730610 FORTIER RENA 30 SHELBURN RD STAMFORD CT 06902-9314 203-276-7058

1003243148 FOX MICHELLE 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 401-626-6500

1366453235 FRAGOMEN THOMAS 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1750356648 FRANCIS GAETANE 159 WEST PUTNAM AVENUE GREENWICH CT 06830-5329 203-869-7080

1598914129 FRANCIS JASMINE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1417174939 FRANK RICHARD 909 HARTFORD TPK UNIT D6 WATERFORD CT 06385-1919 860-440-0700

1942413711 FRATARCANGELI KENNETH 2559 DIXWELL AVENUE HAMDEN CT 06514-1809 203-248-0072

1942531645 FREDERICKS ARLENE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1538100870 FREEDMAN JEFFREY 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1639304868 FREEMAN ANGELA 363 HIGHLAND AVE FALL RIVER MA 02720-3703 508-973-3584

1003113762 FREIMUND JENNIFER 874 HOWARD AVENUE ADLER CENTER NEW HAVEN CT 06520-0210 203-688-9423

1710974464 FREITAG SUZANNE 243 CHARLES STREET BOSTON MA 02114-3002 617-804-4789

1689606832 FRENCH JACQUELINE 223 E 34TH ST NEW YORK NY 10016-4852 646-501-3224

1295763902 FREYLE JAIME 909 49TH STREET BROOKLYN NY 11219-2923 914-962-8290

1053798397 FRIEDLAND MARK 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1659412112 FRIEDLER ALAN 800 BOSTON POST RD SUITE 204 GUILFORD CT 06437-2770 203-245-7575

1285662577 FRIEDMAN STEVEN 909 49TH STREET BROOKLYN NY 11219-2923 914-962-8290

1760823090 FRIEDRICH ANN-KRISTIN 20 YORK ST. YNHH DEPT OF SURGERY NEW HAVEN CT 06520-3220 203-200-2328

1902463482 FRIMPONG JOANITA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-833-5359

1942215454 FROMME ERIK DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6464

HUSKY Health Connecticut Page 19 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 20: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1982681425 FRY BRIAN 34 DALE ROAD SUITE 2018 AVON CT 06001-3659 860-677-0079

1902291693 FRYE RICHARD 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1841204997 FUCIGNA ROBERT 30 SHELBURNE RD STAMFORD CT 06904-9317 203-276-7058

1114194008 FUFA DURETTI 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1588976724 FULLER JOEL 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1952314320 FULTON PAUL 63 HARMONY HILL RD CHEPACHET RI 02814-1429 401-949-0690

1356862247 FULWEILER BERNADETTE 1600 ROCKLAND ROAD WILMINGTON DE 19803-3607 302-651-4548

1194934943 FUNE JIMMY 250 PLEASANT STREET CONCORD NH 03301-2598 603-227-7000

1801038021 FUNKENSTEIN AMY 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1477973378 FUREY KATRINA 300 GEORGE STREET YALE PSYCHIATRY SUITE 901 NEW HAVEN CT 06511-0666 203-785-2095

1750362562 FURIE KAREN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8795

1306938634 GADE NANCY 436 DANBURY ROAD WILTON CT 06897-2023 203-210-7575

1548397920 GAEV BENNETT 167 DWIGHT RD LONGMEADOW MA 01106-1769 413-567-5533

1912977075 GAINES JEFFREY 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-854-2504

1790880169 GAINES SARAH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1134394109 GAINESCARDONE MD ELIZABETH 1290 SUMMER STREET SUITE 3600 STAMFORD CT 06905-5325 203-325-3576

1972545689 GALAN ELIZABETH 95 NEW LITCHFIELD ST TORRINGTON CT 06790-6107 860-482-6513

1720136898 GALECKI SUMMER 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-233-8034

1164908935 GALIONE JANINE 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1710058318 GALLALEE JOHN 55 HARRISON AVE BRANFORD CT 06405-3607 203-488-0440

1598327934 GALLANT JORDYN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1104288406 GALLEGO JOSEPH 300 GEORGE STREET YALE UNIVERSITY NEW HAVEN CT 06511-6663 203-785-2095

1376805622 GALLEGOS KATTAN CESIA 333 CEDAR STREET YNHH CARDIOLOGY NEW HAVEN CT 06520-8017 203-688-9503

1023211653 GALLO CORNELIA 8 BARBARA PLACE WESTPORT CT 06880-1234 203-226-3134

1235431560 GALLO DENISE 2890 MAIN ST. SUITE C STRATFORD CT 06614-5711 203-386-1410

1801978622 GALLO JAMES 828 TOLL GATE RD WARWICK RI 02886-2721 401-615-3043

1326208760 GALLO JORDAN 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1902869902 GALLUZZO KATHLEEN 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1326395971 GANDARILLAS JESUS 897 WEST MAIN STREET DOVER FOXCROFT ME 04426-1029 800-645-3055

1023365707 GANDHI TANUJA 20 YORK STREET YNHH TOMPKINS 2, RM 226 NEW HAVEN CT 06510-3220 203-688-9503

1689019101 GANESHAN SENTHILRAJ 333 CEDAR STREET YALE CARDIOVASCULAR MEDICINE NEW HAVEN CT 06520-8017 203-737-4026

1184656605 GANGADHARAN SIDHARTA 330BROOKLINE AVE BOSTON MA 02115-5400 617-632-8252

1306868138 GANLY IAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1093951790 GARAZI MICHELE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1457750713 GARCIA DAVID 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3813

1689605594 GARCIA FRANCISCO 951 N. WASHINGTON AVE TITUSVILLE FL 32796-2163 800-645-3055

1841415718 GARCIA RINA 1000 AVERY HEIGHTS HARTFORD CT 06106-1304 617-804-5981

1730143124 GARCIA AGUILAR JULIO 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1144298894 GARCIA MOLINER MARIA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5152

1952304263 GARDEN MITCHELL 622 BANTAM RD BANTAM CT 06750-0757 860-361-6650

1952364960 GARDNER DEBRA TORCHIA 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1144263765 GARDNER GINGER 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1710469333 GARDNER ORAWAN 130 DIVISION ST DERBY CT 06418-1326 203-732-7550

1144357583 GARLAND JOSEPH 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2928

1962663351 GARNER AMY 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-7089

HUSKY Health Connecticut Page 20 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 21: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1174559165 GARRETT AUDREY 55 NYE ROAD SUITE 102 GLASTONBURY CT 06033-1281 860-657-3056

1043409667 GARRETT LEILA 1 PERRYRIDGE ROAD GREENWICH CT 06830-4607 203-869-8353

1356781215 GARRICK BENJAMIN 2720 SUNSET BLVD WEST COLUMBIA SC 29169-4810 888-851-7590

1770670358 GARRO ARIS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1841458338 GASKELL ALEXIS 1 BARNARD LN STE 102 BLOOMFIELD CT 06002-2482 860-243-1889

1982151015 GAVILANES AGUIRRE ALBERTO 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-606-4510

1427227818 GAZZOLA DEANA 223 EAST 34TH ST NEW YORK NY 10016-4852 512-767-6140

1275600116 GAZZOLA KRAENZLIN ELENA 150 PURCHASE STREET SUITE 8A RYE NY 10580-2142 914-593-1876

1073925988 GEARY MEGHAN 245 CHAPMAN STREET SUITE 300 PROVIDENCE RI 02905-4539 401-444-4741

1629238886 GEDELA SATISH 1656 CHAMPLIN AVE UTICA NY 13502-4830 800-633-2243

1730458092 GEDIK MUSTAFA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1073627063 GEER ELIZA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1528321734 GEER WALTER 149 NORTH ST WATERVILLE ME 04901-4995 800-645-3055

1538282249 GEETTER DAVID 100 DEERFIELD RD WINDSOR CT 06095-4252 860-270-0600

1659341675 GEFFIN JOEL 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1558346056 GEISSER DANIEL 55 LOCK ST NEW HAVEN CT 06511-3603 203-432-0076

1033279658 GELB DAVID 836 FARMINGTON AVE SUITE 131 WEST HARTFORD CT 06119-1585 860-236-8550

1841379534 GELINAS JOHN 57 NORTH STREET SUITE 419 DANBURY CT 06810-5629 203-778-2020

1487615217 GENGA BRUCE 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1598727836 GENNARELLI LOUIS 16 GUION PL MONTEFIORE NEW ROCHELLE NEW ROCHELLE NY 10801-5502 914-365-3831

1245359009 GENOVA JEFF 38 B GROVE ST. RIDGEFIELD CT 06877-4665 203-438-0458

1104142595 GENTHON ALISSA 375 BOYLSTON STREET BROOKLINE MA 02445 857-307-0861

1104048016 GENTILE ANDREA 546 SOUTH BROAD ST 3B MERIDEN CT 06450-6601 203-237-7449

1669447058 GENTILE PETER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1689749822 GENTILESCO BETHANY 164 SUMMIT AVENUE PROVIDENCE RI 02906-4541 401-793-2500

1548344500 GEORGE GEETA 30 MILESTONE ROAD DANBURY CT 08611-5114 203-702-7400

1437126018 GEORGE SUZANNE 450 BROOKLINE AVENUE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5917

1801209952 GERDNER OSCAR 230 S. FRONTAGE RD. YALE CHILD STUDY CENTER NEW HAVEN CT 06519-1124 203-737-7129

1740527647 GESSLER TESS 109 BELMONT STREET WORCESTER MA 01605-2905 508-334-8152

1649235375 GETSON DAVID 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1619113446 GHANIZADEH HALEH 238 NEWTOWN TURNPIKE REDDING CT 33460-2415 203-664-1977

1134227663 GHODAKE SHASHI 547 MAIN STREET MIDDLETOWN CT 06457-2806 860-346-3081

1821289208 GIANELLONI STARRINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6061

1740218429 GIBBS DIANNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1548284490 GIBBS FRANTZ 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1447411426 GIDDINGS JAMES 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1336128347 GILBERT LAUREN 1600 ROCKLAND ROAD WILMINGTON DE 19803-3607 302-651-4548

1851780233 GILL JESSICA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1831283175 GILL PETER 333 SCHOOL ST PAWTUCKET RI 02860-5334 401-273-0641

1023091949 GILLEN MALINI 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-8392

1699031740 GILLESPIE ERIN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1477087237 GILLSON STEFANIE 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06510-3220 203-785-2095

1023039591 GILSON MICHAEL 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-1004

1437620317 GINGRAS ELIZABETH 281 LINCOLN STREET WORCESTER MA 01605-2138 508-334-5979

1205877446 GINSBURG REBECCA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

HUSKY Health Connecticut Page 21 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 22: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1699896142 GIORDANO ROCCO 36 GRAND STREET FIRST FLOOR HARTFORD CT 06106-4608 860-826-4763

1407933948 GIROTRA MONICA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1164450300 GITLIN JORDAN 1999 MARCUS AVE STE M18 NEW HYDE PARK NY 11042-1023 914-962-8290

1518073386 GITTZUS JENNIFER 246 PLEASANT STREET SUITE 104 CONCORD NH 03301-2548 603-230-1939

1750701801 GLASER JEFFREY 20 YORK ST DEPARTMENT OF SURGERY NEW HAVEN CT 06510-3220 203-688-9503

1194752089 GLASER LEONARD 360-3 NORTH MAIN STREET SOUTHINGTON CT 06489-2503 860-621-8361

1477611101 GLASSER STEVEN 73 NORTH WATER STREET GREENWICH CT 06830-5815 203-531-9354

1609163211 GLENN KELLIE 119 BELMONT STREET WORCESTER MA 01605-2903 508-334-8152

1669581369 GLETZAKOS PETER 595 MAIN STREET PORTLAND CT 06480-1156 860-342-4502

1477504637 GLIEBERMAN OSCAR 108 GROVE STREET 2ND FLOOR WORCESTER MA 01605-2629 508-753-3220

1033524780 GLUCK LAUREN 6 DEVINE ST NORTH HAVEN CT 06473-3129 203-287-6100

1326300963 GODDARD LAUREN 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1473

1730274093 GODIN DAVID 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1952378127 GODWIN LOYD 4 CORPORATE DRIVE SUITE 386 SHELTON CT 06484-6240 203-538-5682

1104893171 GOETZ JORDAN 555 WILLARD AVE VA CONNECTICUT HEALTHCARE NEWINGTON CT 06111-2631 860-666-6951

1598717035 GOKASLAN ZIYA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9132

1023342011 GOLD ANDREA 1011 VETERANS MEMORIAL PARKWAY RIVERSIDE RI 02915-5061 401-432-1000

1053397810 GOLDBERG DAVID 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-921-7566

1275687758 GOLDBERG JONATHAN 4133 WHITNEY AVENUE HAMDEN CT 06518-1432 203-230-2265

1194948323 GOLDBERG JOSEPH 128 EAST AVENUE NORWALK CT 06851-5738 203-854-9607

1154413920 GOLDBERG RICHARD 46 WEST AVON RD. AVON CT 06001-3679 860-675-0262

1104821560 GOLDMAN BORIS 32 IMPERIAL AVENUE WESTPORT CT 06880-4328 203-840-0654

1356610638 GOLDSCHMIDT JEFFREY 6 PARK PLACE NEW BRITAIN CT 06052-1407 860-224-7751

1932591047 GOLDSMITH STEPHANIE 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

1285642595 GOLDSTEIN LEON 141 DURHAM ROAD, SUITE 23 MADISON CT 06443-2658 203-245-0350

1902947484 GOLDSTEIN MARK 1 LONG WHARF DRIVE NEW HAVEN CT 06511-5991 203-538-5682

1891896700 GOLDSTEIN MD LAURENCE 85 SEYMOUR ST SUITE 1025 HARTFORD CT 06106-5530 860-527-8588

1124123559 GOLISANO GARRETT 172 MT. PLEASANT RD. NEWTOWN CT 06470-1443 203-426-0045

1518352459 GOLSHIRAZIAN CORINNE 281 EAST HARTFORD AVENUE UXBRIDGE MA 01569-1278 508-334-6556

1194977603 GONG ZHAODI 60 KATONA DRIVE SUITE 25 FAIRFIELD CT 06824-3544 203-557-3331

1649563784 GONZALEZ ALEJANDRO 3401 NORTH BROAD STREET PHILADELPHIA PA 19140-5103 623-580-6309

1558742312 GONZALEZ MARQUES CATALINA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1619971066 GOOGEL FREDRIC 1268 MAIN STREET SUITE 206 NEWINGTON CT 06111-3038 860-666-5674

1598753006 GORDON EDWARD 388 HARDSCRABBLE RD NO SALEM NY 10560-1020 914-669-5526

1730125618 GORICH GEORGE 672 STONELEIGH AVE C-116 CARMEL NY 10512-4634 914-441-8504

1922505999 GORMAN ALEXANDER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1144415704 GORMAN DANIEL DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6736

1194236869 GORTON CHERYL 701 ENFIELD STREET ENFIELD CT 06082-2961 860-741-6572

1689128548 GOTTIER ALEXANDRA 450 CLINTON STREET THUNDERMIST HEALTH CENTER WOONSOCKET RI 02895-3207 401-767-4100

1508838509 GOTTLIEB LARRY 4697 MAIN STREET BRIDGEPORT CT 06606-1801 203-374-1027

1740405224 GOUDIE JAMES 133 OLD ROAD TO 9 ACRE CORNER CONCORD MA 01742-4159 508-482-9600

1891299103 GOUDREAU SHEA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1174751358 GOULD LAURA ONE GENERAL STREET LAWRENCE MA 01841-2961 978-683-4000

1609847565 GOULET MICHELLE 395 PLEASANT ST NORTHAMPTON MA 01060-3914 413-584-7787

1689805749 GOVOLA DIANA 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-560-6979

HUSKY Health Connecticut Page 22 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 23: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1831585520 GRACE JOANNE 601 E ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1275898249 GRAHAM JAMES 3401 NORTH BROAD STREET PHILADEPHIA PA 19140-5103 623-580-6309

1164538419 GRANIERO RICHARD 4 SHAWS COVE NEW LONDON CT 06320-1234 860-437-3611

1588007314 GRAUER AVERY 175 COPSE RD MADISON CT 06443-0646 203-245-2778

1568029585 GRAVES MOLLY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1285644039 GRAY JENNIFER 455 BOSTON POST ROAD OLD SAYBROOK CT 06475-1505 860-388-9799

1184767741 GREEN AARON 325 9TH AVE SEATTLE WA 98104-2420 206-744-9888

1932149887 GREEN ANDREW 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-490-1939

1750480141 GREEN ERROL 800 WASHINGTON STREET BOSTON MA 02111-1552 617-636-4720

1790931814 GREENFIELD JEFFREY 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1417151663 GREENWALD JULIA 200 SOMERSET ST MILLINOCKET ME 04462-1258 800-645-3055

1881925907 GREENWOOD ANA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1902924103 GREGORY TODD 160 ALLEN STREET RUTLAND VT 05701-4560 802-747-1633

1710908611 GREVE MARK 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1326073495 GRIDER STEPHEN 3000 ARLINGTON AVE TOLEDO OH 43614-2595 419-383-4025

1821431735 GRIEPP MATTHEW 34 PARK STREET NEW HAVEN CT 06519-1109 203-974-7016

1093966954 GRILLS NORA ANN 200 SANDY HOLLOW ROAD MYSTIC CT 06355-1720 860-536-4916

1558743286 GRIMALDO ALICIA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1417376344 GRIMM NATHAN 263 FARMINGTON AVE FARMINGTON CT 06030-4037 860-679-6645

1174556930 GRIN MICHAEL 16 E 40TH ST FL 9 NEW YORK NY 10016-0113 646-736-3110

1316973134 GRONER MICHAEL 55 LOCK ST NEW HAVEN CT 06511-1111 203-432-0290

1316386915 GROOMS AMY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5448

1548680622 GROOMS KYLE 195 EASTERN BLVD SUITE 200 GLASTONBURY CT 06033-1208 860-781-6294

1043640840 GROSS ERNEST 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1174531172 GUARDINO PAUL 501 FARMINGTON AVENUE FARMINGTON CT 06032-1901 860-674-4334

1578704789 GUERRERA ANGELO 2979 MADISON AVENUE BRIDGEPORT CT 06606-2060 203-372-7700

1982082657 GUERRERO BREADY ALMA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1346471521 GUERTIN JENNIFER 119 BELMONT STREET WORCESTER MA 01605-2903 508-334-8152

1730595828 GUERTIN MAGGIE 48 SANDERSON STREET GREENFIELD MA 01301-2778 413-773-2626

1639103955 GUGLIELMO THOMAS 131 KENT ROAD NEW MILFORD CT 06776-3485 203-702-6680

1881661817 GUIDA MANON 622 HEBRON AVE SUITE 107 GLASTONBURY CT 06033-5007 860-657-3376

1902881444 GUILLEM JOSE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1770942302 GUILMET BRITTANY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1205845633 GUMMADAPU RAMKISHA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1952370595 GUNSHER SHARON 246 PLEASANT STREET SUITE 205 CONCORD NH 03301-2548 603-224-0584

1386025468 GUPTA NIKHIL 34 PARK STREET NEW HAVEN CT 06519-1109 203-974-7072

1174613178 GUTIERREZ ELVIRA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1164538070 GUTMAN NED 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1201

1215257548 GUYUMDZHYAN KARAPET 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1366474892 GYURKOCZA BOGLARKA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1619924651 HABR FADLALLAH 950 WARREN AVENUE 3RD FLOOR PROVIDENCE RI 02914-1432 401-606-4260

1053303768 HACK JASON 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1578779740 HACKER DMD ROBERT 134 MONTOWESE STREET BRANFORD CT 06405-3888 203-488-7444

1558539957 HACKETT CHARLES 593 EDDY STREET GRADS DORM PROVIDENCE RI 02903-4923 401-444-4318

1740638881 HADI NEIMA 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

HUSKY Health Connecticut Page 23 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 24: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1770890246 HAENSCH NANCY 181 WHITE STREET LITCHFIELD HALL DANBURY CT 06810-6826 203-837-8590

1659313708 HAGGARTY JOHN 206 SECOND ST EAST BRADENTON FL 34208-1042 702-473-8900

1679665525 HAIMS MARK 1017 FARMINGTON AVENUE WEST HARTFORD CT 06107-2106 860-521-6767

1902205552 HAJJAR RASMI 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1477793917 HAKIMI ABRAHAM 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1407918030 HALL HEATHER 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-4340

1093781908 HALPERN JOHN 336 BAKER AVENUE CONCORD MA 01775-2100 617-906-5063

1427001197 HALPORN JOHN 450 BROOKLINE AVENUE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5450 617-632-3252

1386084887 HAMEL CHERYL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1841429206 HAMILTON HEATHER 4 CORPORATE DR. SUITE 386 SHELTON CT 06484-6240 203-538-5682

1568835007 HAMLETT RACHEL 3300 MAIN ST 3RD FL, SUITE C & D SPRINGFIELD MA 01199-1619 413-794-5600

1649605460 HAMMAD FATMA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1932243870 HAMPTON WILLIAM 90 LONDONDERRY DRIVE GREENWICH CT 06830-3536 203-219-5500

1336124676 HAN YUNCHENG 850 STRAITS TURNPIKE, STE 203 MIDDLEBURY CT 06762-2843 203-758-2300

1578729596 HANASH ALAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1528012747 HANDA SAJEEV 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3985

1912932062 HANDY MARK 4077 5TH AVE. SAN DIEGO CA 92103-2105 800-645-3055

1750602983 HANNA GLENN 450 BROOKLINE AVENUE LW-204 DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5917

1457446817 HANNA RAFIK 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1801844535 HANSBURY EILEEN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1730445552 HANSEN DEREK 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1356459242 HANSON BONNIE 164 HIGH STREET GREENFIELD MA 01301-2613 413-772-0211

1093116212 HAO FANG-YIN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1093748378 HARAPPANAHALLY GITA 335A PRAIRIE AVENUE PROVIDENCE RI 02905-4513 401-444-5685

1255337366 HARDING HALINA 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-423-2616

1306003793 HARDING JAMES 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1629427778 HARDING LISA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1528490018 HARKIN KATHERINE 55 LAKE AVENUE NORTH UMASS MEMORIAL WORCESTER MA 01655-0002 774-443-7552

1508184821 HARKNESS SARAH 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1720126386 HARRINGTON PHILIP 175 GRAND AVENUE NEW HAVEN CT 06513-3939 203-865-1668

1841678547 HARRIS DANIEL 455 TOLL GATE RD WARWICK RI 02886-2759 401-921-7566

1235344367 HARRIS EUGENE 11 UPPER RIVERDALE ROAD SW RIVDALE GA 30274-2615 918-203-0114

1538577168 HARRIS JACQUELINE 759 CHESTNUT STREET 2ND FLOOR SPRINGFIELD MA 01107-1619 413-794-3233

1366836587 HARRIS JAMIE 282 WASHINGTON ST HARTFORD CT 06106-3322 860-837-6262

1508155060 HARRIS JOSHUA 160 ALLEN STREET RUTLAND VT 05701-9997 802-747-1633

1437702735 HARRIS LINDSEY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1588871875 HARRIS MARIEL 199 PARK ROAD EXTENSION SUITE 102 MIDDLEBURY CT 06762-1833 203-437-3121

1831175520 HARRIS MICHELLE ONE GENERAL STREET LAWRENCE MA 01841-2961 978-683-4000

1073070801 HARRIS RACHEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1093933681 HARRIS THELISSA 200 SEABURY DRIVE BLOOMFIELD CT 06002-2650 860-236-2320

1588074637 HARRIS ZACHARY 20 YORK STREET YNHH - INTERNAL MEDICINE NEW HAVEN CT 06510-3220 203-688-9503

1235570110 HARRISON CRAIG 1600 S. ANDREWS AVENUE FORT LAUDERDALE FL 33316-2510 480-977-3271

1033537055 HART ALEXANDER 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1902185184 HART ASHLEY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1841359080 HARVEY MARGARET 31 RIVER RD COS COB CT 06807-2152 203-863-2003

HUSKY Health Connecticut Page 24 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 25: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1851604847 HASAN MARIAM 2425 SAMARITAN DRIVE SAN JOSE CA 95124-3908 888-885-1759

1720154354 HASAPIS PETER 173 EAST AVE NEW CANAAN CT 06840-5614 203-972-4236

1225022973 HASBANI MOSHE 136 SHERMAN AVENUE SUITE 505 NEW HAVEN CT 06511-5235 203-562-8071

1699886358 HASSETT MICHAEL DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-3800

1255405387 HATIBOGLU FERDA 295 WASHINGTON AVE HAMDEN CT 06518-3025 203-248-2500

1649231879 HAUSER MARK 16 CONVERSE AVENUE NEWTON MA 02458-2504 617-969-6331

1982716049 HAY SEONAID 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 866-808-7921

1063487718 HAYDEN DONNA MARIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1669516589 HAYDEN KAREN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4102

1154879674 HAYES ALLISON 84 HOSPITAL AVENUE DANBURY CT 06810-6047 203-792-0400

1629049465 HAYES KATHLEEN 300 SUMMIT STREET HEALTH CTR HARTFORD CT 06106-3100 860-297-2017

1114124294 HAYWARD ALISON 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1518308477 HAYWARD ANTHONY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6484

1700972528 HEALEY JENNY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9167

1376719187 HEANEY JESSICA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1871835876 HEDGECOCK JON 263 FARMINGTON AVE FARMINGTON CT 06030-1921 860-679-4763

1912332396 HEGG JAMES 925 FARMINGTON AVENUE KENSINGTON CT 06037-2295 860-828-0868

1740376706 HEINEMANN MURK 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1689967820 HEINLY ALLISON 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6484

1972686467 HEISLER JEAN 1325 SOUTH CLIFF AVENUE SIOUX FALLS SD 57105-1007 605-322-4976

1225243421 HELMING MARY 275 MT. CARMEL AVENUE QUINNIPIAC UNIVERSITY HAMDEN CT 06518-1905 203-582-3484

1124215983 HENDERSON MARC 255 NORTH MAIN STREET BRISTOL CT 06010-4972 860-589-7170

1548211543 HENNING ALLISON 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1154447712 HENRY JEANNE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-6779

1083683593 HERBERT DANIEL 200 SOMERSET ST MILLINOCKET ME 04462-1258 623-241-8307

1457451551 HERBERT JOSHUA 5 HIGH RIDGE PARK SUITE 103 STAMFORD CT 06905-1328 203-276-2182

1437198702 HERBST ANDREW 148 EAST AVE SUITE 3B NORWALK CT 06851-1481 203-957-3535

1003253063 HERMAN KARL 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1821056615 HERRMANNSDOERFER AXEL 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1780654780 HERSH STANLEY 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1316977119 HESSION MELISSA 701 ENFIELD STREET ENFIELD MEDICAL ASSOC ENFIELD CT 06082-2961 860-741-6572

1861944084 HIGGINBOTHAM THOMAS 1 HOSPITAL PLAZA STAMFORD HOSPITAL STAMFORD CT 06902-3602 646-797-8471

1023147428 HIGGINS DONALD 74 EAST MAIN STREET PLAINVILLE CT 06062-4903 860-793-9613

1366003865 HIGGINS KRISTEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1508969387 HIGGINSON MICHELLE 455 BOSTON POST ROAD OLD SAYBROOK CT 06475-1505 860-388-9799

1578723334 HILLS OSCAR 255 BRADLEY STREET NEW HAVEN CT 06510-1104 203-772-7912

1013168384 HILWA STEVE 9400 TURKEY LAKE RD ORLANDO FL 32819-8001 800-645-3055

1881866465 HINCHEY MYRIAH 27 MAIN STREET HEBRON CT 06248-1514 860-228-1287

1144671934 HINES IMAN 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1083809420 HIRSCH DAVID 250 PLEASANT STREET EMERGENCY DEPT CONCORD NH 03301-7539 951-430-1497

1851514434 HIRSCH SCOTT 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140

1801279427 HIRSCHEGGER KARL 725 NORTH STREET PITTSFIELD MA 01201-4124 413-447-2752

1346625753 HITCHINS ADRIANNA 300 GEORGE ST SUITE 901 NEW HAVEN CT 06511-6624 203-785-2095

1144706631 HOAGLAND CHANA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-716-8780

1710402987 HOBIN SUSAN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-4503

HUSKY Health Connecticut Page 25 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 26: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1477813418 HODAX JONATHAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-490-1939

1235459678 HODES VILLAMAR LINDA 933 BRADBURY DRIVE SE SUITE 2222 ALBUQUERQUE NM 87106-4375 505-272-3295

1346267333 HOFFERT KURT ONE ST. FRANCIS DR GREENVILLE SC 29601-3955 419-226-4343

1538261003 HOFFMAN LYNNE 480 MAMARONECK AVENUE HARRISON NY 10528-1621 914-341-1088

1023053055 HOFFMAN MARC 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1194260984 HOGAN BRITTANY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-1000

1669553830 HOGAN CHRISTOPHER 1250 EAST MARSHALL STREET RICHMOND VA 23298-5051 800-645-3055

1992746135 HOGAN ERIN 455 TOLL GATE RD WARWICK RI 02886-2759 401-273-0641

1164837449 HOGAN KAREN 3300 MAIN STREET SPRINGFIELD MA 01107-1112 413-794-7394

1720380686 HOLDORF JENNIFER 2103 MAIN STREET STRATFORD CT 06615-7184 203-415-1476

1336370246 HOLLAND CRISTINA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1467489302 HOLLEY AARON 303 CATLIN ST BUFFALO MN 55313-1947 612-262-3851

1386044931 HOLLOWITZ YASMIN 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 202-277-4628

1174581516 HOLMES GREGORY 111 COLCHESTER AVENUE FLETCHER ALLEN HEALTH CARE, IN BURLINGTON VT 05401-1473 802-847-0000

1629043997 HOOD TARA 201 W MAIN ST NIANTIC CT 06357-1014 860-451-3068

1225102387 HOPE SUSAN 61 SOUTH MAIN STREET #209 WEST HARTFORD CT 06107-2486 860-313-1352

1962646067 HORBAL TERRENCE 555 BRIDGEPORT AVE 2ND FLR SHELTON CT 06484-4749 203-913-9193

1639324080 HORN AMANDA 43 HIGH STREET WAREHAM MA 02571-2097 508-973-3584

1487965497 HORNER KIMBERLY 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1992124234 HORNG PEARL 1001 SAM PERRY BLVD. FREDERICKSBURG VA 22401-4453 800-645-3055

1255336699 HOROWITZ ROBERT 994 KEMPTON STREET NEW BEDFORD MA 02740-3464 508-973-3584

1952407843 HORTON PAUL 321 RESEARCH PARKWAY SUITE 106 MERIDEN CT 06450-8341 203-235-2505

1508883588 HOSKINS DONNA 62 CARTER ROAD KENT CT 06757-0607 860-927-3772

1851542708 HOTCHKISS KAREN 1 TURKEY HILL ROAD SOUTH WESTPORT CT 06880-5525 203-240-3323

1699154252 HOTTENSTEIN BRIDGET 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1013960582 HOUTCHENS JEANNE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1952468969 HOWARD KATHERINE 500 ENTERPRISE DRIVE ROCKY HILL CT 06067-3913 615-224-5005

1508084377 HOY ERIK 455 TOLL GATE ROAD JOHNSON BUILDING WARWICK RI 02886-2791 401-273-0641

1750393567 HSU HELEN 736 BATTLEFIELD BLVD N CHESAPEAKE VA 23320-4941 800-633-2243

1720059769 HSU KATHARINE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1093371981 HUANG MICHELLE 223 EAST 34TH STREET NEW YORK NY 10016-4852 646-558-0800

1932124450 HUANG RUSSEL 535 E. 70TH NEW YORK NY 10021-4823 646-797-8471

1447291448 HUESGEN CHRISTOPHER 101 HOSPITAL CENTER BLVD STAFFORD VA 22554-6200 800-645-3055

1598105389 HUGHES HANNAH 1060 DAY HILL ROAD WINDSOR CT 06095-5719 860-688-5595

1811959547 HUGHES JEFFREY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1730516147 HULL KATRINA 48 SANDERSON STREET GREENFIELD MA 01301-2778 413-773-2022

1568994523 HULLAND OLIVER 464 CONGRESS AVE SUITE #260 NEW HAVEN CT 06519-1361 203-737-2644

1508290677 HULTS CHRISTINA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1245368513 HUNGERFORD MARYSUSAN 2420 MAIN STREET SUITE 3 STRATFORD CT 06615-1234 203-556-5223

1538111380 HUNT GREGORY 43 HIGH STREET WAREHAM MA 02571-2097 508-973-3584

1437495975 HUSKIC HASNIJA 1579 STRAITS TURNPIKE LOWER LEVEL MIDDLEBURY CT 06762-1836 203-598-7246

1487903431 HUSKINS CHELSEA 20 WEST MAIN ST APT A-201 NORWALK CT 06851-8224 203-371-7838

1528294154 HUSSAIN ZILLA 950 WARREN AVENUE SUITE 301 EAST PROVIDENCE RI 02914-1432 401-606-4260

1225584667 HUSSAINI GRETA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1457863524 HUTCHENS JENNA 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

HUSKY Health Connecticut Page 26 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 27: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1215941893 HWANG MICHAEL 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1225230444 HYDER SARAH 950 WARREN AVENUE 3RD FLOOR PROVIDENCE RI 02914-1432 401-606-4260

1174757629 HYSON ANNE 950 CAMPBELL AVE 11-ACSL-1 WEST HAVEN CT 06516-2770 203-932-5711

1821138165 IANNOLO PATSY 17 LANSING STREET AUBURN NY 13021-1983 877-714-3111

1922557602 IANNOTTI KIMBERLY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

1891133146 IGHILE OMOSEDE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1598944910 IGOE MICHELLE 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-502-9562

1194831925 IJAZ AMBREEN 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-921-7362

1619463890 IM KATRINA 800 CROSS RIVER RD APT. 12C KATONAH NY 10536-3549 914-763-8151

1962705590 IMRAN HAFIZ 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1473

1578554952 INGLIS ALLAN 535 E. 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1720083298 INNAIMO DONN 380 MAIN STREET #5 WATERTOWN CT 06795-2260 860-274-8858

1417374745 IQBAL AMMARAH 333 CEDAR STREET YALE PED EMERGENCY MEDICINE NEW HAVEN CT 06510-3220 203-737-3476

1114286119 IROHAM WILSON 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1760896823 ISA IBRAHIM 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1073554176 ISAACS LAWRENCE 13681 DOCTORS WAY FORT MYERS FL 33912-4309 800-645-3055

1245454115 ISRAELY ROBERT 26 IMPERIAL AVE WESTPORT CT 06880-4308 203-221-1001

1316386360 IUSCO ADRIAN 725 NORTH STREET PITTSFIELD MA 01201-4019 413-881-5427

1326338013 IYER SRAVISHT 1 HOSPITAL PLAZA STAMFORD CT 06902-3602 203-276-7058

1245247311 JACKMAN ALEXIS 3020 WESTCHESTER AVENUE SUITE 303 PURCHASE NY 10577-2525 914-253-8070

1962652487 JACOB ROBIN ONE MEDICAL CENTER BLVD COOKEVILLE TN 38501-0001 931-783-5582

1689641276 JACOBS ALAN 120 EAST 56TH STREET SUITE 1040 NEW YORK NJ 10022-3628 212-888-0002

1649397068 JACOBS ALLAN 61 SOUTH MAIN STREET SUITE 305 WEST HARTFORD CT 06107-2403 860-561-1640

1043271513 JACOBS SUZANNE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1174875421 JACOBSON MELISSA 800 CROSS RIVER ROAD KATONAH NY 10536-0800 914-763-8151

1598807869 JACOBSON STUART 1862 COMMERCE DRIVE BRIDGEPORT CT 06605-2230 203-656-3900

1679522023 JAGUN OLABISI 812 GORMAN AVE ELKINS WV 26241-1484 623-582-2141

1467555342 JAKUBOWSKI ANN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1487086625 JALIL FATIMA 263 FARMINGTON AVE LM068 FARMINGTON CT 06030-1921 860-679-3158

1427137785 JAMAL HABIB 14 RYE RIDGE PLAZA SUITE247 RYE BROOK NY 10573-2858 914-253-4985

1497822605 JAMBOR CLINTON 34 DALE ROAD SUITE 208 AVON CT 06001-3659 860-677-0079

1972753945 JAMES CECELIA 7 OLD SHERMAN TURNPIKE SUITE 102 DANBURY CT 06810-7174 203-947-5529

1821031311 JAMES DIANE 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1538332036 JAMES EFIA 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1326347576 JAMES SCOTT 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1003171075 JAMISON SARAH 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1841627577 JANCZAK HENRY 136 WEST MAIN STREET 2ND FLOOR NEW BRITAIN CT 06051-1315 860-826-4763

1548421613 JANDALI NADIA 315 S MANNING BOULEVARD ALBANY NY 12208-1707 800-645-3055

1972815249 JANDASEK BARBARA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5050

1699206094 JANKE ALEXANDER 464 CONGRESS AVE YNHH EMERGENCY DEPARTMENT NEW HAVEN CT 06519-1313 203-737-2644

1699113480 JARAMILLO STEPHANIE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1851373450 JARNAGIN WILLIAM 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1598781791 JASINSKI PAC JOHN 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 203-810-4151

1104323195 JAVORSKI ANNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1770631368 JAY BRYAN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

HUSKY Health Connecticut Page 27 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 28: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1891130597 JAZIRI KELLY 108 NEW LONDON TPKE. NORWICH CT 06360-2645 860-889-3052

1760538102 JAZIRI WALID 108 NEW LONDON TPKE. NORWICH PSYCHIATRIC CENTER NORWICH CT 06360-2645 860-889-3052

1689802803 JEDICK ROCKY 8280 W WARM SPRINGS ROAD LAS VEGAS NV 89113-3612 800-633-2243

1467487074 JENKINS SALLY 250 PLEASANT STREET CONCORD NH 03301-2598 603-227-7000

1154731743 JENNINGS ERNESTINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9864

1023144771 JERABEK SETH 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1598110215 JERSEY CANDICE 282 WASHINGTON ST HARTFORD CT 06106-3322 860-545-9000

1396888780 JESELSOHN RINATH 450 BROOKLINE AVE BOSTON MA 02215-5405 617-632-3800

1578775243 JIANG JIN 60 WASHINGTON AVE SUITE 202 HAMDEN CT 06518-9999 203-281-6574

1285998740 JILLANI SARAH 20 YORK STREET YNHH- PSYCHIATRY NEW HAVEN CT 06510-3202 203-688-9503

1174943369 JIMENEZ ANDREW 263 FARMINGTON AVE FARMINGTON CT 06030-4037 860-679-6645

1356847172 JIMENEZ HEIDI 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4102

1083955868 JIMMIE KATHLEEN 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 225-573-1905

1124574918 JINDAL ATIN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1487744348 JOBE KATHLEEN 325 9TH AVE SEATTLE WA 98104-2420 206-744-9888

1225170640 JOHN BRIAN 1 HOSPITAL PLAZA STAMFORD HOSPITAL STAMFORD CT 06902-3602 646-797-8471

1346286788 JOHNS MARTIN 15 AIKEN AVENUE FRANKLIN NH 03235-1259 603-524-3211

1841467313 JOHNSON CHRISTOPHER 5801 BREMO ROAD RICHMOND VA 23226-1907 419-226-4343

1316957285 JOHNSON DIANE GRANOFF HALL SCSU 10 WINTERGREEN AVE NEW HAVEN CT 06515-1330 203-392-6300

1811147598 JOHNSON LARRY 25A GREEN HOLLOW ROAD DANIELSON CT 06239-3509 860-779-0374

1306909601 JOHNSTON LISABETH 361 PARK ROAD WEST HARTFORD CT 06119-1644 860-523-1101

1073957288 JOHNSTON MARY 1750 E KEN PRATT BLVD LONGMONT CO 80504-5311 800-645-3055

1306811690 JOLLEY LINDSEY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1427061779 JONAS BRIDGETTE 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1932352051 JONES GAIL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1548450257 JONES KAREN 836 FARMINGTON AVENUE SUITE 229A WEST HARTFORD CT 06119-1505 860-463-2253

1962955591 JONES MADELEINE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1780819144 JONGELING AMY 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140

1487989844 JORDAN DANETTE 44 CONNELL DRIVE STOUGHTON MA 02072-0145 919-998-9451

1346209640 JORDAN RACHEL 250 PLEASANT STREET EMERGENCY DEPT CONCORD NH 03301-7539 951-430-1497

1619035243 JOSE JENNIFER 688 POST ROAD DARIEN CT 06820-4717 203-662-9602

1285101840 JOSEPH ANDREW 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1346256427 JOSEPH JEFFREY 100 MCGREGOR STREET MANCHESTER NH 03102-3730 603-580-6339

1528230463 JOSEPH JOBY 1761 WEST BROAD STREET FRANK A ROSS AND ASSOCIATES STRATFORD CT 06615-5752 203-375-3763

1023437845 JOSEPH OLIVER 455 SOUTH ST STETSON SCHOOL BARRE MA 01005-1005 978-355-4541

1932692704 JOSEPH PRIYA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1851738983 JOSEPH SARAH 447 N. MAIN ST. PITTSFIELD ME 04967-3707 800-645-3055

1780601591 JOSIMOVICH PETER 1234 NAPIER AVENUE SAINT JOSEPH MI 49085-2112 800-645-3055

1760450886 JOSLIN ELIZABETH 915 RIVER ROAD C-25 MIDDLETOWN CT 06457-3921 860-704-4045

1194979674 JOYAL THERESA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-614-0048

1982602868 JOYCE MICHAEL 84 GLASTONBURY BLVD SUITE 101 GLASTONBURY CT 06033-4468 860-652-8883

1013998483 JULIAN JOHN 175 NORTH BEACON STREET WATERTOWN MA 02472-2751 617-312-2699

1871519215 JUNEJA TONY 1215 ROUTE 70 SUITE 2001 LAKEWOOD NJ 08701-7023 732-942-5056

1942711858 JUNGER LUKASZ 187 S CANAAN RD CANAAN CT 06018-2544 860-833-6464

1215910922 JURZYK RONALD 464 WOLCOTT ROAD WOLCOTT CT 06716-2626 203-879-6171

HUSKY Health Connecticut Page 28 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 29: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1710080387 KABAKOFF SETH 928 FARMINGTON AVENUE WEST HARTFORD CT 06107-1929 860-233-2322

1598714701 KACKIELO HANNA 1 TOWNE PARK PLAZA NORWICH CT 06360-2259 317-805-1041

1104073220 KACZANOWSKI KRISTEN 647 CLINTON AVE 2ND FLOOR BRIDGEPORT CT 06605-1711 203-335-7260

1588003339 KADLEC MARY BETH 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1699965871 KAFFMAN ARIE 555 WILLARD AVE VA-MHC NEWINGTON CT 06111-2600 860-666-6951

1427043538 KAGE BARBARA 361 MAIN STREET MANCHESTER CT 06040-4127 860-646-9929

1902891013 KAGE REINHARD 361 MAIN STREET MANCHESTER CT 06040-4127 860-646-9929

1588838155 KAINKARYAM VASANTH 136 COMMERCE WAY SOUTH WINDSOR CT 06074-1155 860-469-5646

1457742934 KAISI MUSTAFA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1760647945 KALAKADA NIRISHA 100 HIGH STREET BUFFALO NY 14203-1126 716-859-8318

1225164320 KALE MILIND 140 GLASTONBURY BLVD. STE 30 GLASTONBURY CT 06033-3920 860-670-2195

1366413304 KALIN MARCIA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1225115645 KALMAN ARLENE 54 ARROWHEAD ROAD BROOKFIELD CT 06804-1532 203-775-6100

1811141120 KALYAN JEFFREY 421 CHEW STREET ALLENTOWN PA 18102-3406 623-582-2141

1831552546 KAMAN KELSEY 333 CEDAR STREET YALE ALLERGY & IMMUNOLOGY NEW HAVEN CT 06510-3206 203-785-4170

1205095882 KAMIHARA JUNNE DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-3270

1982764593 KANABAR HASMUKH 304 WRIGHT STREET SWEETWATER TN 37874-1181 800-645-3055

1528181716 KANDRO SHARON 327 HIGH ST. DAVISON HEALTH CENTER MIDDLETOWN CT 06459-3232 860-685-2470

1598292815 KANG EDWIN 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1952395568 KAPLAN JEFFREY 4699 MAIN STREET SUITE 106 BRIDGEPORT CT 06606-1830 203-374-8182

1154359834 KAPLAN RANA 1275 YORK AVE NEW YORK NY 10065-6007 623-582-2141

1013983691 KARACSONYI EVA 2150 MAIN STREET SPRINGFIELD MA 01104-3300 860-741-6572

1659660132 KARIM NAZ 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1124059134 KARIMI-PASHAKI MOHAMMAD 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1184937922 KARKI KABITA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1366551038 KARL EDWARD 836 FARMINGTON AVE SUITE 131 WEST HARTFORD CT 06119-1585 860-236-8550

1700894177 KARLIN ROGER 88 STATE ROUTE 37 NEW FAIRFIELD CT 06812-5036 203-746-2436

1356343099 KAROSAS LAIMA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-435-5359

1578738787 KARPENOS ILANA CENTER FOR DISCOVERY 1320 MILL HILL RD SOUTHPORT CT 06890-1234 203-955-1381

1649539180 KASBEKAR VISHWALA 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1710085741 KASHAF SUSAN 950 CAMPBELL AVE 11ACSL-B WEST HAVEN CT 06516-2770 866-808-7921

1437613403 KASHMANIAN ALEXANDRA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1689782401 KASSARIS CHRIS 1881 POST RD FAIRFIELD CT 06824-5721 203-255-1036

1023117512 KATIS JAMES 145 OLD MILL ROAD GREENWICH CT 06831-3015 203-622-1213

1386987758 KATSUURA YOSHIHIRO 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1326147257 KATTNER MARIA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1174762165 KATZ ADAM 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 508-334-0042

1205931805 KATZ ROBERT 270 BURNSIDE AVE EAST HARTFORD CT 06108-2315 860-289-9558

1679502140 KATZ STEVEN 664 PROSPECT AVENUE HARTFORD CT 06105-4203 860-231-2850

1134216732 KATZ THEODORE 157 GOOSE LANE GUILFORD CT 06437-2100 203-453-4475

1003839218 KATZMAN GARY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-5891

1154676609 KATZMAN JENNA 21 E 4TH STREET, 7 FL NEW YORK NY 10003-7012 302-313-1584

1598787855 KATZOFF NORMAN 87 SLATER AVENUE JEWETT CITY CT 06351-2408 860-376-2624

1083811525 KAWELO ROXANNE 1319 PUNAHOU ST HONOLULU HI 96826-1001 800-645-3055

HUSKY Health Connecticut Page 29 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 30: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1427387646 KAY LINDA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1306286463 KAZMI FARAZ 263 FARMINGTON AVE FARMINGTON CT 06030-1921 860-588-4390

1225582117 KAZMI SYED 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1821447053 KEAN JANINA 1031 FARMINGTON AVE. FARMINGTON CT 06032-1576 860-677-2550

1356601306 KEARNEY ALEXIS 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-6125

1356533921 KEARNEY JULIA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1295756765 KEATING EDWARD 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

1558390856 KEATING PAUL 196 DANBURY ROAD WILTON CT 06897-4150 203-762-5048

1841245693 KEEDY NATHAN 100 CENTURY DRIVE WORCESTER MA 01606-1244 508-762-5400

1487876272 KEEFE CHARLES 191 ALBANY TPKE CANTON CT 06019-2554 860-693-0887

1508295262 KEISE COLLETE 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-798-5446

1073650685 KEKU JOHN 100 AIRPORT RD. KINSTON NC 28501-1604 800-645-3055

1265808034 KELE MATTHEW 3300 MAIN STREET 3RD FLOOR, SUITE C&D SPRINGFIELD MA 01199-1619 413-794-7033

1740278589 KELLEHER DANIEL 72 NORTH STREET, STE 300 DANBURY CT 06810-5653 203-616-5234

1255547089 KELLEY AARON 421 CHEW STREET ALLENTOWN PA 18102-3406 623-582-2141

1851636369 KELLY BRIDGET 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1568545630 KELLY CARRIE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1518995992 KELLY COLLEEN 593 EDDY STREET PROVIDENCE RI 02905-4923 401-444-6779

1124392352 KELLY SARENA 3203 MAIN STREET BRIDGEPORT CT 06606-4225 203-371-0009

1801867841 KEMENY NANCY 1275 YORK AVE MEMORIAL SOLID TUMOR GROUP NEW YORK NY 10065-6007 646-227-3742

1811420136 KENNEDY ASHLEY 759 CHESTNUT STREET S3677 SPRINGFIELD MA 01107-1619 413-794-5161

1851746135 KENNEDY ELIJAH 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1124178967 KENNESON STEPHEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1841285384 KENNEY LESLIE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

1184695124 KEOHAN MARY 1275 YORK AVE NEW YORK NY 10065-6007 623-582-2141

1578521423 KERR CHRISTINE 21 E 4TH STREET, 7 FL NEW YORK NY 10003-7012 302-313-1584

1306881123 KERSTING JOHN 1 PLEASANT ST MIDDLEBORO MA 02346-1101 508-947-7825

1487641411 KERZER DAVID 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1558416404 KESSELMAN DAVID 326 NICHOLS ROAD HEALTHALLIANCE FITCHBURG FITCHBURG MA 01420-1914 508-334-6173

1679500086 KESSLER FRANK 3423 DANBURY ROAD BREWSTER NY 10509-4513 845-279-7200

1720405194 KESSLER MATTHEW 3423 DANBURY RD BREWSTER NY 10509-4513 845-279-7200

1902035769 KESSLER ROSS 325 9TH AVE SEATTLE WA 98104-2420 206-744-9888

1396710943 KESTER DALE 1901 RED ROCK DRIVE GALLUP NM 87301-1901 800-645-3055

1710395652 KEVILLE TRICIA 80 HIGHLAND AVENUE LACONIA NH 03246-3235 603-524-3211

1225221005 KEYES BRIAN 1400 WHITNEY AVENUE HAMDEN CT 06517-2459 203-248-2116

1538180427 KHAGHAN NEDA 15 VALLEY DRIVE 3RD FLOOR GREENWICH CT 06831-5205 203-489-6900

1942473269 KHAMIS KHAMIS 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1376955088 KHAN AYESHA 65 SANDPIT RD. STE. 308 DANBURY CT 06810-4032 203-743-7264

1891170825 KHAN MOHAMMAD SAUD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1811334949 KHAN NAZIA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1427382399 KHANKHEL ISRAR 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1477048965 KIEFER MICHAEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1528407160 KIKUKAWA TOREY 98 1079 MOANALUA RD AIEA HI 96701-4713 800-645-3055

1164819116 KILCH JOSEPH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3985

1376710665 KIM HAN JO 535 E. 70TH ST NEW YORK NY 10021-4823 646-797-8471

HUSKY Health Connecticut Page 30 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 31: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1093205676 KIM HONG 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1427445485 KIM HYUN HEE 20 YORK ST YALE CHILD STUDY CENTER NEW HAVEN CT 06510-3220 414-736-0406

1477742062 KIM JAE 889 BRIDGEPORT AVENUE MILFORD CT 06460-3139 203-783-9899

1760568000 KIM JOHN 147 EAST CENTER STREET MANCHESTER CT 06040-5242 860-643-9506

1881936037 KIM YEUNJUNG 20 YORK STREET YNHH CARDIOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1487602017 KIM MD HANNA 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1942318209 KIM MD SANG 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1366998478 KIMANI SAMMY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1154459725 KIMPEL JOHN 201 E SAMPLE ROAD POMPANO BEACH FL 33064-3502 954-847-4572

1114472123 KING SUSAN 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-882-8673

1447448477 KING APRN MARJORIE 1320 WEST MAIN STREET BLDG 2 WATERBURY CT 06708 860-282-4128

1790944114 KINGHAM T 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1699794404 KINGSLEY STEPHEN 57 NORTH STREET SUITE 422 DANBURY CT 06810-5629 203-790-0777

1740686369 KIRK ROBERT 1000 WHITE HORSE ROAD STE 802 VOORHEES NJ 08043-4414 856-324-3242

1619224383 KIRKPATRICK ANDREW 23900 KATY FREEWAY KATY TX 77494-1323 713-338-4127

1699937722 KIRSCHNER JONATHAN 535 E. 70TH ST NEW YORK NY 10021-4823 646-797-8471

1215138847 KJERULFF ESENAM 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1003961046 KLAGSBRUN SARAH 800 CROSS RIVER ROAD KATONAH NY 10536-0800 914-763-8151

1528583267 KLAUER JESSIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1407141724 KLAUS CHRISTOPHER 1 RIVER STREET THUNDERMIST HEALTH CENTER WAKEFIELD RI 02879-3214 401-767-4100

1184924565 KLEIN ANDRE 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1033386867 KLEIN RHONDA 761 MAIN AVE SUITE 102 NORWALK CT 06851-1080 203-810-4150

1609861681 KLEIN SCOTT 95 BRADHURST AVENUE VALHALLA NY 10595-1637 914-592-7555

1275970303 KLEINHENZ DOMINIC 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1174579718 KLEMENT GIANNOULA 800 WASHINGTON STREET BOSTON MA 02111-1552 617-636-1465

1407240054 KLIMOVICH JENNA 950 CAMPBELL AVE WEST HAVEN CT 06516-2700 941-232-8099

1568412989 KLIMOWICZ DONNA 555 WILLARD AVE 116-A NEWINGTON CT 06111-2631 860-594-6355

1336137058 KLOTH DAVID 2 RIVERVIEW DRIVE DANBURY CT 06810-6268 203-702-6680

1225023203 KLUGMAN JEFFREY 400 PROSPECT STREET NEW HAVEN CT 06511-2181 203-407-6444

1609854983 KNAPP REBECCA SUSAN WAYNE CENTER 75 CHURCH ST. THOMPSON CT 06277-2609 860-928-5900

1174588875 KNIGHT JEANNE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1473

1699728741 KNOPLOCH SILVIA 698 WEST AVE REHABILITATION CONSULTANTS, PC NORWALK CT 06850-3302 203-523-0100

1720564230 KNOTTS KELSEY 1579 STRAITS TURNPIKE LOWER LEVEL MIDDLEBURY CT 06762-1835 203-598-7246

1386675924 KNOWLES PETER 20 WEST AVON ROAD AVON CT 06001-3677 860-673-0451

1992353908 KNOWLTON KILEY 3300 MAIN STREET SPRINGFIELD MA 01107-1112 413-794-5600

1174898514 KNOWLTON LEAH 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1568486215 KOBAYASHI LEO 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1831208743 KOCHERLA AMY 11 UPPER RIVERDALE ROAD SW RIVERDALE GA 30274-2615 918-429-7518

1285859488 KOCIUBA MARCIN 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1033692819 KODUAH MICHELLE 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-830-2434

1073642393 KOEGLER ALBERT 652 BOSTON POST ROAD SUITE 7 GUILFORD CT 06437-2748 203-453-0015

1659777019 KOERS AMY 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 615-224-5005

1821433053 KOFFER PAUL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3600

1467557264 KOFFLER RICHARD 2 OLD NEW MILFORD RD SUITE 3D BROOKFIELD CT 06804-2426 203-885-0910

HUSKY Health Connecticut Page 31 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 32: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1447515580 KOHLI NINA 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-973-3584

1306855218 KOKERNAK JAMES 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1275608879 KOLADE CHRISTINA 3851 MAIN STREET BRIDGEPORT CT 06606-2864 203-372-3333

1376618611 KOLADE EBENEZER 3851 MAIN STREET BRIDGEPORT CT 06606-2864 203-372-3333

1649292798 KOLENIK MD STEVEN 761 MAIN AVE SUITE 102 NORWALK CT 06851-3628 860-282-4128

1801867692 KOLESNICK RICHARD 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1235169715 KOLEVZON ALEXANDER 1 GUSTAVE L LEVY PL # 1230 MOUNT SINAI MEDICAL CENTER NEW YORK NY 10029-6504 212-659-8792

1790297448 KOLOSKI THERESA 38 MULBERRY ST # 204 LEEDS MA 01053-5339 413-727-3882

1922141381 KOMETZ ROCK SMADAR 1 BRADLEY ROAD, SUITE 707 WOODBRIDGE CT 06525-2296 203-389-7747

1851652549 KONAKONDLA SANJAY 593 EDDY STREET PROVIDENCE RI 02903-4932 401-793-9132

1053332957 KONDEV VANJA 3241 MAIN STREET STRATFORD CT 06614-5236 203-283-9374

1366461568 KONTOS JIMMY 809 82ND PARKWAY MYRTLE BEACH SC 29572-4607 904-688-6190

1396709556 KOPF RICHARD 132 MAIN ST DANBURY CT 06810-7863 203-794-1979

1952586018 KORBLY NICOLE 101 PLAIN STREET 5TH FLOOR PROVIDENCE RI 02903-4825 401-273-0641

1952360430 KOREN JAMES SPEARE MEMORIAL HOSPITAL PLYMOUTH NH 03264-1126 603-536-1120

1770656878 KORVAL ARNOLD 8 WEST END AVENUE OLD GREENWICH CT 06870-1642 203-637-3212

1912031295 KOSTER MICHAEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8360

1669442687 KOSTINA YANINA 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1164654190 KOWALSKI KIRSTEN 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

1770640336 KOZLOWSKI MARK 620 ROUTE 32 UNCASVILLE CT 06382-0566 860-848-1291

1295045680 KOZUB BRADLEY 91 WATER STREET MILFORD MA 01757-3005 508-334-8152

1811005622 KRAVETZ JEFFREY 950 CAMPBELL AVENUE 11ACSL WEST HAVEN CT 06516-2770 203-932-5711

1902001431 KREMSDORF ROBIN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6484

1467481341 KRESSLEY ELISABETH 2 WILDWOOD MEDICAL CENTER ESSEX CT 06426-1428 860-767-2186

1457312100 KRISS TERRENCE 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1245206663 KRITZER LESTER 935 MAIN STREET LEVEL B MANCHESTER CT 06040-6059 860-649-0233

1972602209 KRUGER SUSAN 950 CAMPBELL AVE WEST HAVEN VA WEST HAVEN CT 06516-2770 203-932-5711

1801984927 KRULEE DAVID 433 S MAIN ST STE 225 WEST HARTFORD CT 06110-2812 203-265-4600

1689633018 KRUPP CHRISTOPHER 452 OLD STREET ROAD PETERBOROUGH NH 03458-1263 603-924-4699

1134102395 KUE RICKY 85 EAST CONCORD STREET 3RD FLOOR BOSTON MA 02118-2393 617-414-6033

1992111561 KULKARNI TUSHAR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1548336472 KULOWSKI THOMAS 225 NORTH MAIN STREET SUITE 210 BRISTOL CT 06010-4984 860-582-3744

1083028484 KUMAR ABHISHEK 628B HEBRON AVENUE GLASTONBURY CT 06033-3661 631-833-1160

1922323542 KUMAR THITTAMARANAH 530 FIRST AVE STE 9V NEW YORK NY 10016-6402 516-663-3018

1437602398 KUMARI NEHA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1669566022 KUNDEL LEONARD 1867 SUMMER STREET STAMFORD CT 06905-5016 203-487-6020

1275936056 KUNEC CHRISTINA 1 BLACHLEY RD STAMFORD CT 06902-0002 203-276-2282

1851741755 KUNNATH CLARINA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1912965708 KURIEN SANTHA 27 HOSPITAL AVE SUITE 304 DANBURY CT 06810-5954 203-743-3833

1962645192 KURLANDER CARA 950 CAMPBELL AVENUE FIRM A, MAIL CODE 11ACSL WEST HAVEN CT 06516-2770 203-932-5711

1649547704 KURT HABIBE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5057

1710958111 KUSHNER BRIAN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1518114859 KWAN DANIEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5495

1528534138 LABARR MARTHA 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1174985824 LABER CHELSEA 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-273-0641

HUSKY Health Connecticut Page 32 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 33: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1124061627 LACHER DALE 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5550

1679563324 LACOUTURE MARIO 1275 YORK AVE MEMORIAL DERMATOLOGY GROUP NEW YORK NY 10065-6007 646-227-3742

1073568614 LADDE JAY 52 W UNDERWOOD ST ORLANDO FL 32806-1110 800-645-3055

1154630119 LAFRANCE BARBARA 1153 EAST STREET SOUTH SUFFIELD CT 06080-0001 860-292-3516

1972731776 LAHOUD OSCAR 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1205391893 LAI YUNRU 3 ENTERPRISE DRIVE, SUITE 220 BRIDGEPORT RADIOLOGICAL ASSOC SHELTON CT 06484-4694 203-696-3642

1346211380 LAKE DIANA 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1104147446 LAKIN ASHLEY 111 BREWSTER STREET PAWTUCKET RI 02860-4474 401-273-0641

1598718645 LALIBERTE AMY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1023125598 LAMANA SAMUEL 43 WOODLAND STREET, STE G-80 GOTHIC PARK HARTFORD CT 06105-2363 860-533-3091

1336183235 LAMBERT BRYCE 250 PLEASANT STREET EMERGENCY DEPT CONCORD NH 03301-7539 951-430-1497

1902945058 LAMBRECHT JON 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4102

1447661335 LAMEIRINHAS VIEIRA MARACA DANIELLE 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1477852937 LAMELAS ANDREAS 5 PERRYRIDGE ROAD GREENWICH HOSPITAL GREENWICH CT 06830-4608 203-863-3840

1972951432 LAMELL CAMILLE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 774-443-7552

1285968578 LAMENDOLA KIMBERLY 455 TOLL GATE ROAD WARWICK RI 02886-2756 401-921-7566

1689889578 LANDAU HEATHER 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1144665845 LANDIS RYAN 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1356761829 LANE CHADRICK 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1144245747 LANE JOSEPH 535 EAST 70TH ST NEW YORK NY 10021-4823 631-329-6925

1528038841 LANGE DALE 535 E. 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1952474736 LANOIX RICHARD 95 GRASSLANDS ROAD VALHALLA NY 10595-1652 973-251-1095

1366603573 LANSEN HONORE 21 E 4TH STREET NEW YORK NY 10003-7012 302-313-1584

1619491727 LAPOINTE ALLISON 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1801258157 LARA OSPINA TATIANA 282 WASHINGTON ST HARTFORD CT 06106-3322 860-837-6292

1205096401 LARES DANIELA 134 STATE STREET COMMUNITY HEALTH CENTER, INC. MERIDEN CT 06450-7044 203-237-2229

1538484134 LAROSE CHRISTINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5943

1487687984 LARSON LUCIA 148 WEST RIVER STREET SUITE 1G PROVIDENCE RI 02904-2615 401-793-7817

1578627295 LASKY ERIC 452 OLD STREET ROAD PETERBOROUGH NH 03458-1263 603-924-4699

1932322120 LASSER JAY CENTER FOR WORK STRESS REDUCTI 1031 FARMINGTON AVENUE FARMINGTON CT 06032-1576 860-679-0473

1629003918 LAST GARY 580 COTTAGE GROVE ROAD BLOOMFIELD CT 06002-3032 860-242-8644

1699162826 LASTRA NATALIE 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1922129337 LATOWICKI DANIEL 992 DANBURY ROAD WILTON CT 06897-4808 203-544-9301

1780670240 LAU KIRKLAND 111 SALEM TURNPIKE SUITE 7 NORWICH CT 06360-6459 860-859-2262

1821229386 LAUFER ILYA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1063657526 LAURO JOSEPH 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1457674947 LAVELY RICHARD 20 LITTLE FOX LANE MONROE CT 06468-1607 203-795-4117

1861415762 LAWRENCE KENDRA 555 WILLARD AVENUE NEWINGTON CT 06111-2631 203-932-5711

1386087252 LAWTON KELLEY 36 EAST MAIN STREET AVON CT 06001-3801 860-677-5533

1255838447 LAZAR STACEY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

1578665998 LE QUANG 456 PARK AVE WORCESTER MA 01610-1253 508-796-5661

1306929302 LEALI ALEJANDRO 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1689751935 LEBLANC MEDERIC 173 MIDDLE STREET LANCASTER NH 03584-3508 508-482-9600

HUSKY Health Connecticut Page 33 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 34: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1144203001 LEBOEUF WILLIAM 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-7089

1891716007 LECLAIR WAYNE 452 OLD STREET ROAD PETERBOROUGH NH 03458-1263 603-924-4699

1700085628 LEDDY LAURA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3813

1285149005 LEDER KELSEY 20 YORK STREET SOUTH PAVILION 5-3 NEW HAVEN CT 06510-3220 203-688-5545

1922170679 LEDERMAN LAURENCE 12 CURTIS STREET MERIDEN CT 06450-5900 203-237-5232

1841432903 LEE CHUNG HAN 300 WESTCHESTER RD MSK HARRISON WEST HARRISON NY 10604-6007 646-227-3742

1902284565 LEE DAVID 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1942620356 LEE DIANNE 333 CEDAR STREET YNHH NEONATAL-PERINATAL MEDICI NEW HAVEN CT 06520-3220 203-688-9503

1912970864 LEE LISA 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-221-0797

1396711958 LEE STEVE 535 E. 70TH STREET NEW YORK NY 10021-4823 646-796-8471

1619194560 LEGOLVAN MARK 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-5057

1780692335 LEIBOWITZ LAWRENCE 36 GROVE STREET 1ST FLOOR NEW CANAAN CT 06840-5329 203-966-6305

1972823961 LEINBAUGH ERRYN 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2752

1558302513 LEINHARDT KATHRYN 55 LOCK STREET NEW HAVEN CT 06511-8237 203-432-0076

1831143981 LELEIKO NEAL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8306

1245737105 LENTON MICHAEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1548604283 LENTZ SKYLER 75 BEEKMAN STREET PLATTSBURGH NY 12901-1438 800-645-3055

1043259047 LEON VINCENT 21 E 4TH STREET, 7 FL NEW YORK NY 10003-7012 302-313-1584

1134489644 LEONETTI ADAM 421 CHEW ST ALLENTOWN PA 18102-3406 623-582-2141

1194188334 LEPUS CHELSEA 282 WASHINGTON ST CONNECTICUT CHILDREN''S MEDICA HARTFORD CT 06106-3322 860-545-9560

1114230240 LESKO MELISSA 530 1ST AVENUE HCC SUITE 5D NEW YORK NY 10016-6402 516-663-2818

1790950863 LESOKHIN ALEXANDER 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3813

1154391159 LESSER ROBERT 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1881785673 LESTER MITCHELL 148 EAST AVENUE SUITE 3G NORWALK CT 06851-5727 203-838-4034

1134405970 LEUCHTEN SCOTT 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1215931829 LEVADA ANDREW 1201 MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1821098245 LEVEN LEONARD 3 WEST END AVENUE OLD GREENWICH CT 06870-1640 914-347-4510

1629019807 LEVENSON LAWRENCE 255 BRADLEY STREET NEW HAVEN CT 06510-1108 203-562-3048

1376554923 LEVHEIM LISA 38 MULBERRY ST # 204 LEEDS MA 01053-5339 413-727-3882

1518955236 LEVI DAVID 131 KENT ROAD BLDG A NEW MILFORD CT 06776-3485 203-758-2523

1679508469 LEVIN GALE 52 BEACH ROAD SUITE 104 CYRIL WAYNIK MD PC FAIRFIELD CT 06824-6017 203-254-2000

1649339003 LEVINE ADAM 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1154473817 LEVINE RONALD 475 COGNEWAUGH RD COS COB CT 06807-1108 203-629-5560

1306040860 LEVINE SARA GREENWICH ADOLESCENT MEDICINE 239 GLENVILLE ROAD GREENWICH CT 06831-4172 203-532-1919

1225004765 LEVINE STEVEN 160 HAWLEY LANE SUITE 202 TRUMBULL CT 06611-5379 203-380-3707

1790992196 LEVINE WENDY 1275 POST RD STE 202 FAIRFIELD CT 06824-6024 203-259-0880

1467593806 LEVINSON ANDREW 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1962461202 LEVITAN RICHARD 600 ST JOHNSBURY ROAD LITTLETON NH 03561-3437 603-444-9271

1568457679 LEVITT JACOB 5 EAST 98TH STREET, 5TH FLOOR BOX 1048 NEW YORK NY 10029-6574 212-241-9728

1427465319 LEVY BENJAMIN 263 FARMINGTON AVE FARMINGTON CT 06030-1921 860-679-6645

1427361112 LEVY JILLIAN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1245244458 LEWANDER WILLIAM 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1972887511 LEWIS ELLEN 8 LINCOLN STREET WESTPORT CT 06880-4201 203-916-4000

HUSKY Health Connecticut Page 34 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 35: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1184972994 LEWIS HARRISON 2 MEDICAL CENTER DRIVE SUITE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1629464862 LEY MATHEW 3001 BROADMOOR BLVD NE RIO RANCHO NM 87144-2100 800-633-2243

1912109265 LEYTIN VICTORIA 455 TOLLGATE ROAD WARWICK RI 02886-2759 401-273-0641

1295919140 LI RONALD 3001 BROADMOOR BLVD NE RIO RANCHO NM 87144-2100 800-633-2243

1316956501 LIAN GANG 180 WESTBROOK ROAD, BLDG 5 ESSEX CT 06426-1517 860-767-1034

1568947026 LICCIARDO ANNA 158 POMFRET STREET PUTNAM CT 06260-1800 860-963-2250

1598855728 LICHTER ARLEN 1320 WEST MAIN ST BLDG #2 WATERBURY CT 06708-3131 203-755-9355

1023039146 LIEBMANN OTTO 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1609835362 LIEBOWITZ NEIL 1031 FARMINGTON AVENUE FARMINGTON CT 06032-1411 860-677-2550

1669584686 LIGHAM DWIGHT 1 LONG WHARF DR STE 212 NEW HAVEN CT 06511-5593 203-624-4208

1659465003 LIGORSKI MARK 72 NORTH ST. SUITE 201 DANBURY CT 06810-5653 203-798-0068

1346479334 LIN EMERALD 535 E 70 ST HOSPITAL FOR SPECIAL SURGERY NEW YORK NY 10021-4823 212-774-7598

1760845630 LIN ERIC 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06510-3220 203-785-2095

1316906498 LIN NANCY 450 BROOKLINE AVE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-3800

1740294461 LINAKIS JAMES 593 EDDY STREET CLAVERICK 2 PROVIDENCE RI 02903-4923 401-854-2504

1982757555 LINDBLAD ROY 325 MAIN STREET FARMINGTON CT 06032-2977 860-677-7753

1841283736 LINDEN ROBERT 789 HOWARD AVENUE NEW HAVEN CT 06519-1304 203-688-5555

1710991435 LINDQUIST DAVID 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1992874812 LINKE GARY 60 WASHINGTON AVE HAMDEN CT 06518-3271 203-288-9944

1043230600 LINN NOREEN 222 WESTCHESTER AVENUE SUITE 205 WHITE PLAINS NY 10604-2926 914-949-9882

1508897786 LINSEISEN JERRY 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661-8973 802-888-8313

1366842635 LIPKIN SARAH 950 CAMPBELL AVE BULD# 36, MAIL CODE 116 A4 WEST HAVEN CT 06516-2770 203-932-5711

1407873334 LIPMAN STEPHEN 230 BROAD STREET WINDSOR CT 06095-2925 860-688-4634

1528243367 LIPPMANN MELANIE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1114089687 LIPSCHITZ DEBORAH 140 SHERMAN STREET 5TH FLOOR FAIRFIELD CT 06824-5825 203-256-9926

1720617996 LIPTAK STEPHANIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1922039353 LISS MARCIA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5776

1710954318 LISTMAN DAVID 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1447341243 LITCHMAN MARK 148 EAST AVENUE SUITE 3G NORWALK CT 06851-5727 203-838-4034

1629462858 LITTAUER ROSS 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1174642797 LITTELL NANCY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1457454738 LIU ALLEN 11234 ANDERSON ST LOMA LINDA CA 92354-2804 800-645-3055

1194076703 LIU SANNIU 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1578709044 LIVINGSTONE TAMARA 759 CHESTNUT STREET S3677 SPRINGFIELD MA 01107-1619 413-794-5161

1881701365 LO CONRAD 2 MEDICAL CENTER DRIVE STE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1003855339 LOCKHART GREGORY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1548282569 LOCKHART JEFFREY 246 PLEASANT STREET SUITE 103 CONCORD NH 03301-2548 603-224-6070

1841282381 LOFARO JOSEPH 25 POCONO RD DENVILLE NJ 07834-2954 918-203-0114

1881094936 LOGUE NICOLE 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 203-228-2116

1770758419 LOKICH ELIZABETH 101 DUDLEY ST PROVIDENCE RI 02905-2401 401-921-7362

1346467164 LOMBARDI KRISTIN 1 HOPPIN STREET SUITE 304 PROVIDENCE RI 02903-4141 401-444-4612

1225102247 LONDON DAVID 567 VAUXHALL STREET EXTENSION SUITE 218 WATERFORD CT 06385-4332 203-623-4400

1982014353 LONDONO ALICIA 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1821183377 LONGO MICHAEL 16 MAIN STREET LLA EAST HAVEN CT 06512-2919 203-468-7181

1578649786 LONGSHORE CARROL 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

HUSKY Health Connecticut Page 35 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 36: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1518913094 LORCH JOCHEN 450 BROOKLINE AVE BOSTON MA 02215-5405 617-632-3090

1609094549 LOREFICE LAURENCE 1445 EAST PUTNAM AVE OLD GREENWICH CT 06870-2222 203-637-4006

1629043963 LOTA CONRADO 800 CROSS RIVER ROAD KATONAH NY 10536-0800 914-763-8151

1598702326 LOUDERMILK ANN 55 FOGG ROAD WEYMOUTH MA 02190-2432 781-624-3889

1881744456 LOUIT AYMERIC 148 EAST AVENUE SUITE 3G NORWALK CT 06851-5727 203-838-4034

1578551040 LOULOUDES JENNIFER 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-8515

1962400200 LOWNEY MARK 363 HIGHLAND AVE FALL RIVER MA 02720-3703 508-973-3584

1871908731 LU YI 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1134212798 LUCAS CYNTHIA 2 MEDICAL CENTER DRIVE SPRINGFIELD MA 01199-1619 413-794-7020

1730154790 LUCERO MARK 636 DEL PRADO BLVD CAPE CORAL FL 33990-2695 800-645-3055

1801114483 LUCHIN ANA 2776 CLEVELAND AVE FORT MYERS FL 33901-5864 800-645-3055

1487766101 LUCIANO DANIEL 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140

1528016441 LUM JO 1 LONG WHARF DE STE 212 NEW HAVEN CT 06511-5593 203-624-4208

1891834958 LUTTMANN CHRISTOPHER 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-4102

1922087832 LYNCH DARREN 395 PLEASANT ST NORTHAMPTON MA 01060-3914 413-584-7787

1275557019 LYNCH DAVID 15 OLD PARK LANE NEW MILFORD CT 06776-2507 860-354-3632

1134136658 LYNCH GEORGE 55 FOGG ROAD SOUTH WEYMOUTH MA 02190-2432 781-792-4136

1962902536 LYNCH JODY 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-614-1617

1376958520 MA RUI 1047 OLD POST ROAD FAIRFIELD CT 06824-0001 203-254-2006

1750371811 MACDONALD JEANNE 55 FRUIT ST BOSTON MA 02114-2696 617-724-9040

1942415146 MACDOUGALL DONALD 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-5057

1467406678 MACHRA GURPREET 161 MT. PELIA ROAD MARTIN TN 38237-3811 800-645-3055

1760438212 MACK BJERREGAARD JUNE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-6195

1497866875 MACKEY JENNIFER 423 LONG HILL RD. GROTON CT 06340-3812 860-449-8330

1245258441 MACKIE JR W ANDREW 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1740342013 MACKINTOSH BARBARA 950 CAMPBELL AVE WEST HAVEN CT 06516-2700 203-932-5711

1962860601 MACPAINTSIL-OSTROM STACEY 1000 WHITE HORSE ROAD STE 802 VOORHEES NJ 08043-4414 856-324-3242

1598020034 MADADI ANIL 725 NORTH STREET PITTSFIELD MA 01201-4019 413-881-5427

1336683952 MADDEN ALIZA 800 CROSS RIVER RD KATONAH NY 10536-3549 845-592-2763

1063438612 MAGNUS PATRICK 246 PLEASANT STREET SUITE 103 CONCORD NH 03301-2548 603-224-6070

1508067109 MAGRAS LAWRENCE 11 FAIRFIELD BLVD WALLINGFORD CT 06492-1828 203-949-4000

1437312139 MAHAJAN RAAKHEE 254 EASTON AVENUE NEW BRUNSWICK NJ 08901-1766 623-241-8350

1417251513 MAHFOUD JOSE 60 LAFAYETTE STREET SUITE 633 BRIDGEPORT CT 06604-5462 203-576-0345

1265859144 MAHMUD SIDRAH 20 YORK STREET YNHH NEUROLOGY NEW HAVEN CT 06510-3220 203-688-9503

1962757039 MAHON KATHERINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1992816169 MAHON SELWYN 111 BREWSTER STREET PAWTUCKET RI 02860-4474 401-921-7566

1124394820 MAIERS TRAVIS 1 CAPITAL WAY PENNINGTON NJ 08534-2520 215-442-5084

1144280637 MAIOCCO KENNETH 4639 MAIN STREET BRIDGEPORT CT 06606-1832 203-374-5546

1942523303 MAITRA SUBHANKAR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1306162748 MAJUMDER DIMPLE 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274-2615 918-203-0114

1801870506 MAKARETZ MICHAEL 149 NORTH ST WATERVILLE ME 04901-4995 800-645-3055

1699733618 MAKDISI TONY 725 NORTH STREET PITTSFIELD MA 01201-4019 413-496-6820

1467488510 MAKKAR HANSPAUL 21 SOUTH ROAD UCONN MEDICAL GROUP FARMINGTON CT 06032-6231 860-679-4600

HUSKY Health Connecticut Page 36 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 37: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1407845332 MALANE MICHELLE 1781 HIGHLAND AVENUE CHESHIRE CT 06410-1254 203-272-3376

1023306974 MALEKI SARA 593 EDDY STREET APC 12 PROVIDENCE RI 02903-4923 401-444-8515

1780098384 MALHOTRA DEVIKA 9407 CUMBERLAND ROAD NEW KENT VA 23124-2029 804-966-1628

1609846120 MALHOTRA VIVEK 1275 YORK AVE MEMORIAL ANESTHESIOLOGY GROUP NEW YORK NY 10065-6007 646-227-3742

1942684469 MALIK MISHIKA 282 WASHINGTON ST HARTFORD CT 06106-3322 860-837-6227

1376864371 MALIK MOHSIN 6 SHAWS COVE SUITE 204 NEW LONDON CT 06320-4969 203-538-5682

1245321553 MALINA ALAN 95 SCOVILL STREET WATERBURY VA PRIMARY CARE CENT WATERBURY CT 06706-1113 203-932-5711

1265517015 MALINCONICO STEPHEN 770 ORANGE ST NEW HAVEN CT 06511-5622 203-624-2280

1609810548 MALONEY WILLIAM 503 N MAPLE STREET EFFINGHAM IL 62401-2006 800-645-3055

1265940068 MANCINI JESSICA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-606-1611

1215075908 MANDELBAUM CHAIM 75 MAIDEN LANE SUITE: 1206 NEW YORK NY 10038-5162 646-602-8030

1669408696 MANDELBAUM DAVID 335R PRAIRIE AVENUE ATTN: PROVIDER ENROLLMENT PROVIDENCE RI 02905-1924 401-444-4318

1639239668 MANGADA KRISTIN DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-3796

1649444209 MANGIAMELI ELIZABETH 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1831143387 MANGRAY SHAMLAL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5057

1952593782 MANISCALCO MARTHA TRINITY COLLEGE HEALTH CENTER 300 SUMMIT STREET HARTFORD CT 06106-3100 860-297-2026

1063613719 MANJU ALEX 100 HIGH STREET BUFFALO NY 14203-1126 716-859-8318

1477508372 MANLEY PETER 450 BROOKLINE AVE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5704 617-632-4386

1518989789 MANNING CAROL 400 BALD HILL ROAD WARWICK RI 02886-1692 401-384-6444

1922061647 MANNING DANA 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1083896906 MANNION MICHELE 3423 DANBURY ROAD BREWSTER NY 10509-4513 845-279-7200

1932212982 MANOLIO RICHARD 736 N BATTLEFIELD BLVD CHESAPEAKE VA 23320-4941 800-633-2243

1184638157 MANTIKAS GEORGE 142 EAST HIGH ST EAST HAMPTON CT 06424-1545 860-267-6666

1568416980 MANTILLA FANNY 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1174518708 MARASA RICHARD 25 RIDGEWOOD ROAD SPRINGFIELD VT 05156-3050 508-482-9600

1487286563 MARCIL MICHAYLA 2 MEDICAL CENTER DRIVE SUITE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1154834786 MARCOU JORDAN 5520 PARK AVENUE SUITE WP2-200 TRUMBULL CT 06611-3463 410-329-1071

1679597744 MARCUS NORMAN 30 E. 40TH STREET STE 1100 NEW YORK NY 10016-1203 212-532-7999

1366512402 MARGOULEFF DONALD 39-31 211TH STREET BAYSIDE NY 11361-1957 718-428-1011

1083876213 MARIN ADRIAN 703 MAIN ST EMERGENCY DEPT. PATERSON NJ 07503-3079 973-754-2249

1366418758 MARINGOLA JR RONALD 197 WEST MAIN STREET MERIDEN CT 06451-4141 203-237-6325

1235283243 MARINI LUCIANO 26 LAKESIDE BLVD EAST WATERBURY CT 06708-2916 203-575-9097

1174088298 MARKEY KATE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1265843718 MARKO STEPHEN 20 YORK STREET YNHH EMERGENCY MEDICINE NEW HAVEN CT 06510-3220 203-737-2644

1194128637 MARKS BRIENNE 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-8853

1982770145 MARKS LAURA 1563 POST ROAD EAST WESTPORT CT 06880-5602 203-319-3939

1154354256 MAROLDA THEODORE 16 HINSDALE AVE. WINSTED CT 06098-1108 860-379-7198

1073550307 MAROTTA ROCCO 9 KEELER COURT RIDGEFIELD CT 06877-1000 732-828-0361

1083612527 MARQUEZ LUIS 1306 FERNANDEZ JUNCOS AVENUE SAN JUAN PR 00907-4127 787-480-3000

1861662975 MARRERO STEIN MARGOT CHILDREN''S & WOMENS PHYSICIAN 503 GRASSLANDS RD VALHALLA NY 10595-1503 914-304-5313

1841629482 MARTIN DANIELLE 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-8515

1316299704 MARTIN JULIE 1 TOWNE PARK PLAZA NORWICH CT 06360-2559 317-805-1041

1962409102 MARTIN LAUREEN 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

HUSKY Health Connecticut Page 37 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 38: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1356520647 MARTIN THOMAS 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1831276021 MARTINS SUSAN 170 HAZARD AVE ENFIELD CT 06082-4520 860-749-2022

1992919187 MARTINUCCI ERICA 1981 EAST MAIN ST WATERBURY CT 06705-1822 203-709-6794

1033378948 MARUSZAK SANDRA 15 AIKEN AVENUE FRANKLIN NH 03246-1259 603-524-3211

1528118031 MARYESKI STEPHANIE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-3800

1700224656 MASHAYEKH MOHAMMAD 75 SEMINARY HILL RD CARMEL NY 10512-1921 845-225-3400

1386610699 MASIH RAVI 410 S 11TH ST LAKE WALES FL 33853-4203 800-645-3055

1427219765 MASKARA PAMELA 225 MAIN ST , SUITE 104 SUITE 104 WESTPORT CT 06880-5525 203-227-7530

1801817234 MASON KATHERINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4318

1043867666 MASON NICOLE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1861749327 MASSA LAURA 593 EDDY STREET STE 101 PROVIDENCE RI 02903-4923 401-444-6779

1700197548 MASSIGNAN JASON 2 BERNARDINE DR NEWPORT NEWS VA 23602-4404 419-226-4343

1417000357 MASSINGHAM LAUREN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1740230358 MASTINO CHRISTOPHER 314 RIVERSIDE DRIVE FAIRFIELD CT 06824-6072 203-685-6326

1629237987 MATASAR MATTHEW 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1699979542 MATERN ELIZABETH 20 WEST MAIN STREET SECOND FLOOR AVON CT 06001-3716 860-470-7909

1669490561 MATHASON MARK ONE CAPITAL WAY PENNINGTON NJ 08534-2520 215-442-5146

1285085886 MATHEW MARINA 52 BEACH ROAD STE 104 FAIRFIELD CT 06824-6017 203-254-2000

1790054526 MATHEWS SAM 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1073683280 MATHIAS TAMAR 7 KENOSIA AVE DANBURY CT 06810-6047 475-329-2678

1053473983 MATO ANTHONY 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1336260512 MATROS EVAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1073584538 MATTHEWS LAURA 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

1992870638 MATULONIS URSULA DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-2334

1104945708 MATYAS JANELLEN 4 SHAWS COVE #202 NEW LONDON CT 06320-4902 860-443-4199

1831531334 MAXWELL LINDA 300 BOSTON POST ROAD HEALTH SERVICES WEST HAVEN CT 06516-1916 203-932-7079

1912324005 MAYA SUSAN 950 CAMPBELL AVE. BLDG 2 WEST HAVEN CT 06516-1111 203-932-5711

1861669814 MAYBERG STEPHANIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1386630085 MAYER FERN 132 MORGAN STREET STAMFORD CT 06905-5431 203-969-0123

1659361327 MAYER ROBERT 450 BROOKLINE AVENUE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-4500

1407882921 MAYMAN DAVID 535 E. 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1760801484 MAYNARD DOUGLAS 255 N 30TH ST LARAMIE WY 82072-5140 800-645-3055

1083090849 MAYNARD MICHAELA 1125 NORTH MAIN STREET PROVIDENCE RI 02904-5739 401-793-2928

1881841989 MAYS JOELLE 101 HOSPITAL CENTER BLVD. STAFFORD VA 22554-6200 800-645-3055

1083708945 MAZEIKA CAMDEN 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1033509567 MAZUMDER NABILA 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1281

1649279951 MAZUR ROBERT 5353 REYNOLDS ST SAVANNAH GA 31405-6015 623-241-8312

1336221563 MAZZONI PAOLA 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1033176896 MC ALLISTER PETER 30 BUXTON FARMS ROAD SUITE 230 STAMFORD CT 06905-5362 203-914-1900

1568413326 MCALLISTER SARAH 52 BEACH RD FAIRFIELD CT 06824-5663 203-254-2000

1760607659 MCATEER KRISTINA 455 TOLLGATE ROAD WARWICK RI 02886-2759 401-273-0641

1437416898 MCCAFFREY RYAN ONE GENERAL STREET LAWRENCE MA 01841-2961 978-683-4000

1497173108 MCCANN ANGELA 158 POMFRET STREET PUTNAM CT 06260-1800 860-963-2250

1164401493 MCCARTHY CHRISTINE 185 BIRCH STREET WILLIMANTIC CT 06226-2295 860-465-0185

1427022565 MCCARTIE JOHN CROTCHED MOUNTAIN REHAB CTR ONE VERNEY DRIVE GREENFIELD NH 03047-5000 603-547-3311

HUSKY Health Connecticut Page 38 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 39: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1356573265 MCCLOSKEY LUANNE 2 MEDICAL CENTER DRIVE SUITE 309 SPRINGFIELD MA 01107-1270 413-794-5363

1053517946 MCCLURE MEKEESHA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 615-496-4052

1114404126 MCCOOL MICHAEL 2344 BOSTON ROAD WILBRAHAM ROAD MA 01095-1104 413-596-5550

1477648285 MCCOWAN PATRICIA 281 LINCOLN STREET WORCESTER MA 01605-2138 508-793-6348

1134774516 MCDONNELL KELSEY 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-530-7007

1467463414 MCDONOUGH JOANNE 1101 NOTT STREET SCHENECTADY NY 12308-2425 385-695-1941

1760773287 MCDOUGALL JOHN 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1376947432 MCDOWELL ANDREW 1 LONG WHARF DR STE 212 NEW HAVEN CT 06511-5593 203-676-1524

1063628295 MCFARLAND WARD 527 TUNXIS HILL RD INTEGRATED MEDICAL CENTER OF F FAIRFIELD CT 06825-4473 203-333-7788

1689634115 MCGINNIS DAVID 43 HIGH STREET EMERGENCY DEPARTMENT WAREHAM MA 02571-2097 508-973-3584

1023009230 MCGOLDRICK PATRICIA 141 SOUTH CENTRAL PARK AVENUE HARTSDALE NY 10530-2340 914-428-0529

1770034746 MCGRATH MEGAN 189 STORRS RD MANSFIELD CENTER CT 06250-1683 860-465-5904

1861940090 MCGROARTY JESSICA 84 HOSPITAL AVENUE DANBURY CT 06810-6047 203-792-0400

1114985769 MCHUGH MICHAEL 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2721

1639665789 MCKENNA DEBORAH 86 BEACH ST WESTERLY RI 02891-2718 401-829-2654

1386683555 MCLAUGHLIN CAROLYN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1669518932 MCLAUGHLIN KEVIN 148 EAST AVENUE SUITE2F NORWALK CT 06851-5726 203-866-0061

1144331166 MCNAMARA CYNTHIA 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 203-932-5711

1760450860 MCNAMARA ROBERT 3401 NORTH BROAD STREET PHILADELPHIA PA 19140-5103 215-707-1429

1336161132 MCPHERSON PHILLIP 1 BROOKDALE PLZ BROOKLYN NY 11212-3139 800-645-3055

1992857619 MEANDZIJA BORISLAV 255 BRADLEY STREET NEW HAVEN CT 06510-1105 203-865-3646

1528168879 MECKEL MARIE 11 WILBRAHAM RD SPRINGFIELD MA 01199-3161 413-794-3710

1083633242 MEDEIROS CARROLL 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1427324607 MEDIDI SUNIL 1 TAMPA GENERAL CIRCLE TAMPA FL 33606-3571 888-851-7590

1538207147 MEGIBOW CRAIG 300 FEDERAL ROAD STE 103 BROOKFIELD, CT 06804-2412 203-775-1800

1962439786 MEHDI SYED 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1281

1437134426 MEHRARA BABAK 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1578982880 MEHTA SHAILJA 20 YORK STREET OBSTETRICS AND GYNECOLOGY NEW HAVEN CT 06510-3220 203-785-6927

1053844779 MELDRUM JONATHAN 464 CONGRESS AVENUE YNHH EMERG MED, STE #260 NEW HAVEN CT 06519-1361 203-737-2644

1184760175 MELIA MICHAEL 736 BATTLEFIELD BLVD N CHESAPEALE VA 23320-4941 757-312-6404

1053706887 MENCHER SHANA 20 YORK STREET YNHH PEDIATRIC ENDOCRINOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1255500153 MENDELSOHN ROBIN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1114109212 MENDES ASANTE 152 SIMSBURY ROAD BLDG 9, 2ND FLOOR AVON CT 06001-3777 860-384-2492

1538247481 MENDILLO ANDREA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1689660748 MENENDEZ BENNY 1600 SOUTH ANDREWS AVENUE FORT LAUDERDALE FL 33316-2510 954-473-7642

1093245748 MENGUAL ROSE 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1063621506 MENNESSON MICHEL 175 ARCH BRIDGE ROAD BETHLEHEM CT 06751-1613 203-266-6164

1043429756 MERCK LISA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1790051431 MEREA VALERIA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1598860389 MEROLLI ALISA 455 TOLL GATE RD WARWICK RI 02886-2759 401-663-0159

1407072838 MERRIAM PRISCILLA DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-5917

1265960397 MERRITT MATHEW 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5550

1649614868 MERRITT RORY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

HUSKY Health Connecticut Page 39 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 40: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1023280328 MERTZ CHRISTOPHER 250 PLEASANT STREET CONCORD NH 03301-2598 603-227-7000

1881771574 MESSINA DINO 111 BREWSTER ST. PAWTUCKET RI 02860-4474 401-729-2000

1790704690 MESSING BLAINE 28 CROSS HWY BLAINE E. MESSING,MD,MSW,LLC WESTPORT CT 06880-2140 203-505-1492

1639172265 MESSING MEREDITH 500 ENTERPRISE DR ROCKY HILL CT 06067-3913 615-224-5005

1154346831 METCALF MARCIA 38 BRIDGE ST. EAST WINDSOR CT 06088-1014 860-729-8628

1992045694 MEYER AMANDA 2 MEDICAL CENTER DRIVE SUITE 503 SPRINGFIELD MA 01107-1619 413-794-5600

1659748028 MEYER SARA 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-338-6600

1710053939 MEYERS JOHN 128 EAST AVENUE NORWALK CT 06851-5738 203-857-1866

1164732038 MIAH BAHAR 735 S. 5TH AVE. WAUCHULA FL 33873-3100 800-645-3055

1558586164 MICELI JOSEPH 106 NOROTON AVE DARIEN CT 06820-5237 203-655-9922

1174886469 MICHAEL AUSTIN 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2726

1992745111 MICHAUD JACQUELINE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1285294157 MIGANI ANDREW 532 CHAPEL STREET NEW HAVEN CT 06511-6905 203-865-4286

1780650143 MIHALEY SOBELMAN DEBORA 628 HEBRON AVENUE GLASTONBURY CT 06033-1541 860-494-4600

1225294978 MIKNAITIS REBECCA 21298 OLEAN BLVD PORT CHARLOTTE FL 33952-6705 888-851-7590

1477024065 MILES HANNIBAL 1817 BLACK ROCK TPKE SUITE 205 FAIRFIELD CT 08625-3546 203-717-1339

1124129226 MILES MELISSA 11 WILBRAHAM ROAD SPRINGFIELD MA 01109-3161 413-794-3710

1326528415 MILLER JACLYN 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-565-4190

1184692162 MILLER JEFFREY 6 SHAWS COVE SUITE 101 NEW LONDON CT 06320-4969 860-444-9022

1881631000 MILLER KENNETH 800 WASHINGTON STREET BOSTON MA 02111-1526 617-636-5000

1316138043 MILLER KIMBERLY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1194727487 MILLER PAUL 251 NORTH FOURTH STREET OAKLAND MD 21550-1375 800-645-3055

1336255470 MILLER PAUL 258 MAIN AVE NORWALK CT 06851-2748 203-846-3424

1528099876 MILLER ROBERT 11101 N SHERMAN RD EDGERTON WI 53534-9002 800-645-3055

1225418122 MILLER ZHANNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1437266079 MILLIKEN LAURA 100 HAYNES STREET,2ND FLOOR DEQUATTRO CANCER CENTER MANCHESTER CT 06040-4113 860-533-3091

1487696282 MILLMAN ERIC 64 TRUMBULL STREET NEW HAVEN CT 06510-2118 203-865-1390

1689096588 MILNE MARIBETH 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-772-3291

1295969533 MILOUSHEV VESSELIN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1679538334 MINTZ ABRAHAM 115 TECHNOLOGY DRIVE SUITE B106 TRUMBULL CT 06611-6339 203-372-6460

1083682082 MINTZ JOSHUA 1400 STATE ST SPRINGFIELD MA 01109-1671 413-726-6702

1912344045 MIRAU DANIEL 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1417083221 MIRTCHEVA-TROCHEVA ROSNA 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1881779288 MISRI ASHISH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1699801431 MITCHELL DEBORAH MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST BOSTON MA 02114-2621 617-643-0711

1134258486 MOHAN AVINASH 5 PERRYRIDGE RD GREENWICH CT 06830-2180 914-517-7981

1467943100 MOHN WILLIAM 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1205800463 MOHRER PETER 5 DURHAM RD SUITE 5B GUILFORD CT 06437-2076 203-453-4870

1366436230 MOK KI TAE 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1811156052 MOMTAZ PARISA 1275 YORK AVENUE NEW YORK NY 10065-6007 647-227-3764

1821164609 MONETTE ALISON 158 POMFRET STREET AVENA MEDICAL CENTER, LLC PUTNAM CT 06260-1800 860-963-2250

1518057942 MONSARRAT MICHAEL 37 N. MAIN ST KENT CT 06757-0268 860-927-3519

1780683847 MONSEAU VINCENT 1500 N 28TH ST RICHMOND VA 23223-5332 419-226-4343

1003312281 MONTEIRO REGINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

HUSKY Health Connecticut Page 40 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 41: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1962664755 MONTERO PAOLA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1225006877 MONTI JAMES 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1336325596 MOORCROFT JILL 279 NEW BRITAIN RD #6 BERLIN CT 06037-3165 860-438-7096

1598941585 MOORCROFT THOMAS 279 NEW BRITAIN RD #6 BERLIN CT 06037-3165 860-438-7096

1588700538 MOORE EILEEN 108 NEW LONDON TPKE. NORWICH CT 06360-2645 860-889-3052

1205060167 MOORE ELISABETH 59 PAGE HILL RD BERLIN NH 03570-3531 603-326-5827

1033260310 MORAN BRETE 5 SOUTH MAIN STREET BRANFORD CT 06405-3845 203-483-8656

1518306638 MORANT RICARDO 1358 BOSTON POST RD OLD SAYBROOK CT 06475-6475 860-388-3522

1467574582 MORELLI MARIANNE 834 FEDERAL ROAD, SUITE A BROOKFIELD CT 06804-2324 203-775-6167

1790051977 MORENO DE LUCA DANIEL 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1609804905 MORGAN HARRY 55 NYE ROAD SUITE 102 GLASTONBURY CT 06033-1281 860-657-3056

1225285430 MORGAN HEATHER 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1497714570 MORGAN JEFFREY DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-5204

1770551467 MORGAN MICHELLE 149 NORTH ST WATERVILLE ME 04901-4995 800-645-3055

1578708111 MORGENTHALER DIANE SCSU GRANOFF HALL 10 WINTERGREEN AVENUE NEW HAVEN CT 06515-1355 203-392-6311

1194223164 MORIARTY ROSE 593 EDDY STREET PROVIDENCE RI 02905-4923 401-444-3777

1215265582 MORIN DANIEL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1922130137 MORISSETTE LEE 289 COUNTY ROAD WINDSOR VT 05089-9000 802-674-7333

1467444562 MORMILE JOHN 234 MAIN ST PORTLAND CT 06480-1861 860-342-7277

1811994957 MORREN CHRISTOPHER 20 YORK STREET NEW HAVEN CT 06510-3202 203-688-2984

1003172586 MORRIS JULIE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9864

1760834824 MORRIS MOLLY 1 BLACHLEY RD STAMFORD CT 06902-0001 212-774-7598

1992718233 MORROW MAUREEN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1902469604 MORSTON DANYELLE 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1811018401 MORTON LOIS 2 BENEDICT PLACE GREENWICH CT 06830-5358 203-622-6551

1962567826 MOSKALEWICZ THOMAS 200 KENNEDY MEMORIAL DRIVE WATERVILLE ME 04901-4526 800-645-3055

1881850626 MOSKOWITZ ALISON 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1689625188 MOSS JEREMY 4639 MAIN STREET MOSS AND MAIOCCO MD LLC BRIDGEPORT CT 06606-1832 203-374-5546

1881195048 MOTT GLENN 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

1477937696 MOUSTAFA ABDELMONIEM 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1932318110 MOVVA SUJANA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1003369042 MOWAFY MAHMOUD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1316205719 MUCARIA DANETTE 291 LINCOLN STREET MCPAP WORCESTER MA 01605-3643 508-334-6556

1205816451 MUELLER BORIS 300 WESTCHESTER RD MSK HARRISON WEST HARRISON NY 10604-6007 646-227-3742

1497763080 MUELLER FRIEDRICH 999 SUMMER STREET SUITE 200 STAMFORD CT 06905-9998 203-357-7773

1154376929 MUELLER PAULA 52 W UNDERWOOD ST ORLANDO FL 32806-1110 800-645-3055

1255778155 MUFSON JEFFREY 300 GEORGE ST. SUITE 901 RM. 25 NEW HAVEN CT 06511-6662 203-785-2095

1972693711 MUGGIA VICTORIA 111 EAST 210 STREET DTC-3 BRONX NY 10467-2490 718-920-5439

1982958328 MUJIB MARJAN 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1588750269 MULHERN BARBARA FAIRFIELD UNIVERSITY 1073 NORTH BENSON ROAD FAIRFIELD CT 06824-5195 203-254-4011

1790710986 MULLEN JOHN 131 KENT ROAD NEW MILFORD CT 06776-3485 203-702-6640

1437239704 MULLEN PETER 16 SUNNY VALLEY RD NEW MILFORD CT 06776-3323 860-354-1400

1023409596 MULLER BRIANNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1770051294 MUMBA PAMELA 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-6297

HUSKY Health Connecticut Page 41 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 42: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1245783380 MUNDAY PA_C DANIELLE 761 MAIN AVE SUITE 102 NORWALK CT 06851-0500 860-282-4128

1407118763 MUNNANGI LAKSHMI 84 HOSPITAL AVENUE DANBURY CT 06810-6047 203-792-0400

1750556353 MURPHY CASSANDRA 555 WILLARD AVE NEWINGTON CT 06111-2631 203-932-5711

1194777557 MURPHY DANIEL 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1659501377 MURPHY EMILY 593 EDDY STREET JANE BROWN PROVIDENCE RI 02903-4923 401-444-5448

1376924993 MURPHY MATTHEW 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1760927552 MURPHY MICHELLE 130 DIVISION ST DERBY CT 06418-1326 203-732-7541

1154379691 MURRAY TODD 29 LEWIS AVE GREAT BARRINGTON MA 01230-1713 413-881-5427

1689883837 MURTY DEIRDRE 324 ELM STREET MONROE CT 06468-3244 203-216-4906

1104117860 MUSITS ANDREW 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1750324356 MYERSALBARIDI PA ERIN 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1982755088 MYSELS DAVID 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1356507933 NA MICHELLE 2 POMPERAUG OFFICE PARK SOUTHBURY CT 06488-2288 203-264-1620

1811942915 NABATI LIDA DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6464

1861400814 NADKARNI SIDDHARTHA 223 EAST 34TH ST NEW YORK NY 10016-4852 631-232-4260

1366535163 NAGALLA BHAVANI VA CONNECTICUT HEALTH CARE 555,WILLARD AVE NEWINGTON CT 06111-2600 860-666-6951

1174910566 NAGARAJAN REGINA 300 GEORGE STREET SUITE 901 NEW HAVEN CT 06511-6662 203-785-2095

1679908206 NAHAR RICHA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2104

1649627951 NAHASS MEGHAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1750834438 NAJEEB FATIMA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1669769261 NAKHLA JONATHAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9132

1548454622 NALLY MD JENNIE 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1548480577 NAMIN SAMAD 43 HIGH POINT CIRCLE RYE BROOK NY 10573-1092 914-320-6165

1033496948 NANKANI DEEPA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1952355174 NAPOLI ANTHONY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1194861609 NARAD JOAN 7 NORTH COVE ROAD OLD SAYBROOK CT 06475-2538 860-304-2049

1982616520 NASCIMENTO JOAO 3203 MAIN ST BRIDGEPORT CT 06606-4225 203-371-0009

1376953588 NATALE RYAN 1 CAPITAL WAY PENNINGTON NJ 08534-2520 215-442-5084

1942773304 NATARELLI NICOLE 1 BLACHELY ROAD STAMFORD CT 06902-0002 203-590-3100

1134133804 NATHANSON ANDREW 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1740417468 NATHENSON MICHAEL DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5450 617-632-5204

1346596830 NAWABI DANYAL 535 E. 70TH ST NEW YORK NY 10021-4823 646-707-8471

1891953196 NAYAK LAKSHMI DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5450 617-632-2166

1891783361 NAZARIO STEVEN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1629379631 NAZARIO VANESSA 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 203-510-9131

1669888475 NAZIR UMAIR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1891728853 NEGBENEBOR DARLENE STAMFORD GASTROENEROLOGY STAMFORD CT 06905-2451 203-998-7400

1164406930 NEILL MARGUERITE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-3929

1568866796 NEILSON DANIEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1598760522 NELSON HEIDI 45-12 41ST STREET SUNNYSIDE NY 11104-3419 718-784-2699

1881618304 NELSON JONATHAN 33 CEDAR STREET RYE NY 10580-2031 914-921-4874

1942257449 NEMCHENOK LINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1053676809 NERAGIMIANDOAB SIYAMEK 530 1ST AVE STE 9V NEW YORK NY 10016-6402 516-663-8798

1609154483 NESBITT TRESA 901 18TH ST E TIFTON GA 31794-3699 800-645-3055

1255345179 NESTOR ELIZABETH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

HUSKY Health Connecticut Page 42 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 43: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1801816798 NEUREITHER LAWRENCE 573 HOPMEADOW STREET SIMSBURY CT 06070-2462 860-658-0010

1558781039 NG STEPHANIE 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1619913175 NGO HUAN 680 CENTRE STREET BROCKTON MA 02302-3308 508-482-9600

1861739518 NGONGMON PASCAL 101 HOSPITAL CENTER BLVD. STAFFORD VA 22554-6200 800-645-3055

1861041121 NGUYEN HUONG 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-518-6951

1811381452 NICHOLS CAITLIN 333 CEDER ST. NEONATAL-PERINATAL MEDICINE NEW HAVEN CT 06510-3206 203-688-2320

1730193814 NIEGO SARA 52 BEACH ROAD STE 104 FAIRFIELD CT 06824-6017 203-254-2000

1336278043 NIELDS JENIFER 108 OLD ORCHARD PARK FAIRFIELD CT 06824-6606 203-259-5812

1518901552 NOBLE JAMES 246 PLEASANT STREET SUITE 104 CONCORD NH 03301-2548 603-230-1939

1346579471 NOE PATRICIA 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1316192354 NOEL-VULPE HERRALAN 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 917-208-7739

1942734751 NOORI NADIA 8 LINCOLN ST, FIRST FLOOR WESTPORT CT 06880-4201 203-916-4600

1235662354 NOORI SOFIA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1083640965 NOORMOHAMED AKBAR 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1174750806 NORVAL CHRISTOPHER 645 FARMINGTON AVENUE HARTFORD CT 06105-2946 860-570-3400

1033472568 NOTIK SHIMRAT 999 SUMMER ST STE 305 STAMFORD CT 06905-5513 203-428-4440

1831488691 NOURANI MONA 1400 S DOBSON RD MESA AZ 85202-4707 385-695-1936

1750307948 NOVELLA MICHELE 7 OLD SHERMAN TURNPIKE SUITE 102 DANBURY CT 06810-4174 203-947-5529

1134268287 NOWAK ANDREW 11 FRIENDSHIP STREET BLDG 2B NEWPORT RI 02840-2209 401-793-3000

1780797860 NOYESDUGUAY LISA 85 BEACH STREET WESTERLY RI 02891-0717 401-596-8311

1235512708 NUNNALLY BRANDON 1500 N 28TH ST RICHMOND VA 23223-5332 419-226-4343

1376885467 NWACHUKWU BENEDICT 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1710279427 NWOSU OBINNA 169 MARTIN AVE EPHRATA PA 17522-1724 800-645-3055

1831503739 NYKIEL JENNIFER 29 LEWIS AVE GREAT BARRINGTON MA 01230-1713 413-881-5427

1619910155 O BRIEN KELLYANN 3400 MAIN STREET SPRINGFIELD MA 01107-1113 413-794-9560

1043230030 O'BRIEN JAMES 101 DUDLEY STREET PROVIDENCE RI 02906-2401 401-273-0641

1841583093 O'BRIEN JENNIFER 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1881896629 O'BRIEN JILL 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1245761519 O'DELL RYAN 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1356671887 O'REILLY COLIN 200 SOMERSET ST NEW BRUNSWICK NJ 08901-1942 908-301-5402

1518938075 O'REILLY RICHARD 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1093027278 OBASARE EDINRIN 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1518339019 OBERTIS NICHOLAS 75 SEMINARY HILL RD CARMEL NY 10512-1921 845-225-3400

1598745978 OBORNE KAMMILLE 48 SANDERSON STREET GREENFIELD MA 01301-2778 413-773-2851

1770566689 OBRIEN MARTHA 300 SUMMIT ST HEALTH CENTER HARTFORD CT 06106-3100 860-297-2018

1134504715 OBRIEN NICHOLAS 60 NORTH MAIN STREET 3RD FLOOR WATERBURY CT 06702-1443 860-417-8633

1275589442 OBRIEN RICHARD 1656 CHAMPLIN AVENUE UTICA NY 13502-4830 800-633-2243

1457514580 OCAMPO CARLOS 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1285716183 OESER LINDA 285 SHAKER ROAD ENFIELD CT 06082-5123 860-253-8378

1982629655 OESTREICHER MARK 160 HAWLEY LANE SUITE 104 TRUMBULL CT 06611-5379 203-377-0639

1134255771 OGLAND OLAF 19 HALLS RD, SUITE 235 OLD LYME CT 06371-0046 860-434-9400

1083689020 OGRADY JOHN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1104830173 OGUNBAMERU EMILOLA 703 MAIN STREET PATERSON NJ 07503-3079 973-754-2000

1790909737 OHARA NANCY 3 HOLLYHOCK RD WILTON CT 06897-4443 203-834-2813

HUSKY Health Connecticut Page 43 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 44: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1124516208 OJSERKIS RACHEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-2315

1104092048 OKEH VICTOR 11 UPPER RIVERDALE ROAD SW RIVERDALE GA 30274-2615 918-429-7518

1922276708 OKONIEWSKI ANASTASIA 134 STATE STREET MERIDEN CT 06450-3293 203-237-2229

1588776173 OLIN CRAIG 5 HIGH RIDGE PARK SUITE 103 STAMFORD CT 06905-1326 203-276-2182

1831146877 OLIVA JEANNE 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1473

1356315576 OLIVERIO SUSAN 245 CHAPMAN STREET SUITE 300 PROVIDENCE RI 02905-4513 401-444-6715

1538678487 OLIVO JESSICA 75 SEMINARY HILL RD CARMEL NY 10512-1921 845-225-3400

1871553024 OLSEN KEVIN 200 SOMERSET ST MILLINOCKET ME 04462-1258 800-645-3055

1871543009 OLSON BEATRIZ 1625 STRAITS TURNPIKE, STE 207 MIDDLEBURY CT 06762-2846 203-758-2594

1457476210 OLUWA TOPE 279 LINCOLN STREET WORCESTER MA 01605-2120 508-334-6556

1922052687 OMARA THOMAS 144 STATE STREET PORTLAND ME 04101-3776 800-645-3055

1205879608 OMARA TIMOTHY 481 KINGSTOWN ROAD WAKEFIELD RI 02879-3626 401-789-0283

1861434607 ONEILL DARREN ENFIELD MEDICAL ASSOCIATES 701 ENFIELD STREET ENFIELD CT 06082-2961 860-741-6572

1417297508 ONYERIKWU OKONTA 168 DAHL AVE STRATFORD CT 06614-2701 203-455-7688

1275534281 ORBAN ZSOLT 111 BREWSTER STREET PAWTUCKET RI 02860-4474 401-921-7566

1831446970 OREILLY ELIZABETH 450 BROOKLINE AVE, BOSTON MA 02215-5405 617-632-3495

1356329155 ORGAN SCOTT 641-B CLARK AVENUE BRISTOL CT 06010-4068 860-582-6603

1548365372 ORLANDO MARSHA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1790132066 ORLANSKY ELCHANAN 5520 PARK AVENUE SUITE WP2-200 TRUNBULL CT 06611 203-743-7264

1366609760 OSEI DANIEL 535 E 70TH ST NEW YORK NY 10021-4823 212-774-7598

1073556841 OSTROVSKAYA ANNA 55 LOCK ST NEW HAVEN CT 06511-3603 203-432-0240

1295987287 OSULLIVAN RICHARD 55 BRADLEY ROAD MADISON CT 06443-6606 203-444-6639

1447661251 OTTERSON ERIC 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1225468267 OUELLETTE SARAH 146 WEST RIVER STREET SUITE 11A PROVIDENCE RI 02904-2609 401-793-8770

1730563354 OUIMETTE TAMMI 2 MEDICAL CENTER DRIVE SUITE 308 SPRINGFIELD MA 01107-1271 413-794-7020

1801827209 OVERMOYER BETH DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-3800

1205807997 OVERMOYER SARAH 455 BOSTON POST ROAD OLD SAYBROOK CT 06475-1505 860-388-9799

1073689238 OWENS JEFFREY 1563 POST ROAD EAST WESTPORT CT 06880-5602 203-319-3939

1083001747 OYEWOLE OYEDOTUN 355 NEW SHACKLE ISLAND ROAD ATTN EMILY JOHNSON HENDERSONVILLE TN 37075-2479 727-507-2519

1558673764 OZERSKY IRINA 530 FIRST AVENUE SUITE 7Q NEW YORK NY 10016-6402 516-663-3018

1972762722 PACHECO JOSHUA 29 LEWIS AVE GREAT BARRINGTON MA 01230-1713 413-881-5427

1043435134 PACHOLSKI VANESSA 970 FARMINGTON AVENUE SUITE 201 WEST HARTFORD CT 06107-2139 860-561-4300

1619421518 PACHOWSKA JUSTYNA 2928 MAIN STREET SUITE 200 GLASTONBURY CT 06033-1007 860-633-2248

1497021620 PAGAN-VEITH JOHANNA 223 EAST 34TH STREET NEW YORK NY 10016-4852 516-663-8798

1699866780 PAGANE JOSEPH 52 W UNDERWOOD ST ORLANDO FL 32806-1110 800-645-3055

1770699365 PAGGIOLI JOHN 190 W. TOWN STREET ADVANCED DIAGNOISTIC PAIN TREA NORWICH CT 06360-2131 203-676-1524

1124041538 PALINSKI SUZANNE 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-444-6779

1447819024 PALMER KATHERINE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-0605

1700815032 PALMER LANE 1999 MARCUS AVE STE M18 NEW HYDE PARK NY 11042-1023 914-962-8290

1265599278 PALUMBO JOSEPH 15 CHURCH LANE EAST LYME CT 06333-1621 860-739-3447

1235303652 PANDA MEGHA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1336537315 PANEK MAGDALENA 223 NORTH VAN DIEN AVENUE RIDGEWOOD NJ 07450-2726 201-291-6086

1396393484 PANKIW LAUREN 3300 MAIN STREET 3RD FL, SUITE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1053752022 PANLILIO-ORTIZ MARIA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 607-203-1919

HUSKY Health Connecticut Page 44 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 45: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1851362685 PAPADOPOULOS ESPERANZ 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1467620500 PAPOLOS DEMITRI 22 CRESCENT RD WESTPORT CT 06880-4509 203-226-2216

1356508006 PAPPALARDO JULIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1376547992 PAPPAS ESTELL 330 ORCHARD STREET, 2ND FLR NORTHEAST MEDICAL GROUP, INC. NEW HAVEN CT 06511-4417 203-789-3152

1801205752 PARIKH KRUTI ONE GENERAL STREET LAWRENCE MA 01841-2961 978-683-4000

1225078348 PARK JOEL 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1326076795 PARKER PRIOR 200 SANDY HOLLOW ROAD MYSTIC CT 06355-1720 860-536-4916

1669924452 PARKER STACY 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

1437308186 PARKER SYLVIA 400 CAPITAL BLVD ROCKY HILL CT 06067-2678 203-687-7875

1841651718 PARSLOW NATALIE 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1639111008 PARSONS JULIAN 61 SOUTH MAIN STREET SUITE 202 WEST HARTFORD CT 06107-2403 860-521-1264

1477606655 PASSARETTI DAVID 722 POST ROAD DARIEN CT 06820-4731 203-656-9999

1750470878 PASSER LUCILLE 380 PLAINFIELD STREET SPRINGFIELD MA 01107-1524 413-794-4458

1710935481 PATEL BHAVESH 1579 STRAITS TURNPIKE LOWER LEVEL MIDDLEBURY CT 06762-1835 203-598-7246

1639112352 PATEL BHUPENDRA 65 JAMES STREET EDISON NJ 08820-3947 800-645-3055

1659356566 PATEL BRIAN 211 PARK STREET ATTLEBORO MA 02703-0963 508-236-7040

1588755011 PATEL DANIEL 780 MAIN ST., STE.1 GREAT BARRINGTON MA 01230-2180 413-528-2418

1003134370 PATEL JHARANA 1350 S HICKORY STREET MELBOURNE FL 32901-3278 623-582-2141

1760808711 PATEL KUNAL 169 MARTIN AVE EPHRATA PA 17522-1724 800-645-3055

1033409073 PATEL MINESH 1177 HIGH RIDGE RD STAMFORD CT 06905-1221 203-703-2555

1831188374 PATEL SIMA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1528306586 PATEL SNEHAL 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1841272689 PATEL SNEHAL 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1356725063 PATHAK AMRIT 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1548262660 PATRICK GEORGE 550 GOSHEN ROAD P0 BOX 161 LITCHFIELD CT 06759-0161 860-567-8350

1336355114 PATTERSON BRUCE 177 BOSTON POST ROAD BOX 254 WATERFORD CT 06385-2803 860-447-2235

1588611578 PATTI ERNEST 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1255731394 PAUDEL PRAKASH 725 NORTH STREET PITTSFIELD MA 01201-4016 413-881-5427

1811963200 PAUL SUCHARITA BUFFALO GENERAL HOSPITAL 100 HIGH ST BUFFALO NY 14203-1126 716-859-8318

1245340348 PAYETTE CHRISTOPHER 263 POMFRET ST PUTNAM CT 06260-1835 860-928-3667

1952575573 PAYETTE MICHAEL 21 SOUTH ROAD DERMATOLOGY FARMINGTON CT 06032-6231 860-679-3692

1992942205 PEABODY SHERI 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-819-0330

1912932385 PEARL ADAM 15 CORPORATE DRIVE SUITE 2-8 TRUMBULL CT 06611-1351 203-452-7081

1801107172 PELKEY BLUM JESSICA 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1740662154 PELLEGRINO MELISSA 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-8515

1114060506 PELLEGRINO MICHAEL 363 HIGHLAND AVE FALL RIVER MA 02720-3703 508-973-3584

1518003474 PELLETIER JASON 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1568805125 PELUSO FRANCESCO 300 GEORGE STREET SUITE 901 NEW HAVEN CT 06511-6662 203-785-2095

1487992434 PENA BAEZ SANTIAGO 13681 DOCTORS WAY FORT MYERS FL 33912-4309 800-645-3055

1104250943 PENIGALAPATI DAMODAR 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1700874955 PENNEY KEITH 538 LITCHFIELD ST. G-01 CTR FOR ADV ORTHO & SPORTS CAR TORRINGTON CT 06790-6669 860-496-9877

1982665725 PENNOYER JENNIFER 47 JOLLEY DRIVE BLOOMFIELD CT 06002-3092 860-882-6168

1376077339 PENQUE BRENT 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

HUSKY Health Connecticut Page 45 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 46: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1730195751 PERERA TARIQUE 84 HOSPITAL AVENUE DANBURY CT 06810-6047 203-792-0400

1225181274 PERGIOVANNI EDWARD 825 F CROMWELL AVENUE ROCKY HILL CT 06067-3013 860-721-9002

1700229168 PERGIOVANNI MARY 825 CROMWELL AVE SUITE F ROCKY HILL CT 06067-3007 860-721-9002

1881953990 PERKINS TIFFANY 111 MICHIGAN AVENUE NW WASHINGTON DC 20010-2970 301-572-3591

1497075485 PERRY GREGORY 600 NORTHERN BLVD. ALBANY NY 12204-1004 800-645-3055

1548378813 PESCE JOSEPH 4699 MAINST SUITE 212 BRIDGEPORT CT 06606-1830 203-372-8949

1770691552 PESCE KATHERINE 4699 MAIN STREET, SUITE 212 BRIDGEPORT CT 06606-1830 203-372-8949

1598951741 PESHORI SANGEETA 915 RIVER ROAD MIDDLETOWN CT 06457-2797 860-704-4000

1740700368 PETERSEN LENA 75 SEMINARY HILL RD CARMEL NY 10512-1921 845-225-3400

1205850377 PETHICK MARK 532 CHAPEL STREET NEW HAVEN CT 06511-6905 203-865-4286

1699881284 PETRONIO ANGELA 501 FARMINGTON AVENUE FARMINGTON CT 06032-1901 860-674-4334

1932391091 PETTY PAUL 309 JACKSON STREET MONROE LA 71201-7407 800-645-3055

1790874683 PEYSER MARC 778 LONG RIDGE ROAD SUITE 102 STAMFORD CT 06902-1251 203-329-7122

1962647743 PEZZINO PAUL 330 MAIN STREET 2ND FLOOR HARTFORD CT 06106-1860 203-518-4888

1881795508 PHAM DEANNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1306245691 PHELPS KIMBERLY 21 E 4TH STREET NEW YORK NY 10003-7012 302-313-1584

1497267629 PHILLIPS CHANTELL 6 GREENWICH OFFICE PARK GREENWICH CT 06831-5151 203-869-1145

1952423188 PHILLIPS JAMES 300 BROOKLINE AVE BOSTON MA 02215-5400 617-754-9051

1396241972 PHILLIPS MEGAN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-5161

1306876255 PHILLIPS STEVEN 944 DANBURY ROAD WILTON CT 06897-4909 203-544-0005

1760918262 PHIN NICOLE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1023189370 PIANKA JOSEPH 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-421-6306

1144584327 PICONE ANIELLO 954 SOUTH MAIN ST PLANTSVILLE CT 06479-1645 860-628-4761

1447524228 PICONE JOSEPH 954 SOUTH MAIN STREET PLANSTVILLE CT 06479-1645 860-628-4761

1730606740 PIKE JORDAN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1112 413-794-6279

1043212350 PINTO MD FRANK 761 MAIN AVE SUITE 201 NORWALK CT 06851-0001 860-282-4133

1528545845 PIRES GERARDA 1305 POST ROAD SUITE 10 FAIRFIELD CT 06824-0619 203-259-7709

1982706032 PITEGOFF JOHN 1225 SILVER STREET MIDDLETOWN CT 06457-3920 860-638-2620

1649304775 PIVNICK BARRY 61 WESTFARMS MALL D111 FARMINGTON CT 06032-2631 860-561-5687

1831291368 PIVOR JEFFREY 495 CONNECTICUT AVE NORWALK CT 06854-1724 203-838-3321

1568659514 PIZARRO LOPEZ SANDRA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1013179878 PLITAS GEORGE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1295889681 PLYMOUTH CARINE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1619203031 POLITIKOS IOANNIS 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1437399904 POLLACK BRIAN 17 CEDAR STREET NEW BRITAIN CT 06052-1301 860-832-8625

1710966924 POLSON KATHLEEN DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-5917

1801817705 POMERANIEC LAZARO ONE POST ROAD FAIRFIELD CT 06824-6241 203-255-7617

1902857915 PONCE ANIBAL 725 NORTH STREET PITTSFIELD MA 01201-4124 413-477-2752

1114192242 PONCE DORIS 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1376938399 POOLEBOYKIN COLETTE 230 SOUTH FRONTAGE RD NEW HAVEN CT 06519-1124 203-737-7129

1558366419 POPE CHRISTIAN 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1427062033 PORTELLI DAVID 593 EDDY STREET SUITE 101 PROVIDENCE RI 02903-4923 401-444-6125

1184683328 POSTERARO JR ANTHONY 199 PARK ROAD EXTENSION SUITE 102 MIDDLEBURY CT 06762-1833 203-437-3111

1487853594 POSTOW MICHAEL 1275 YORK AVENUE NEW YORK NY 10065-6007 646-227-3764

1598887218 POTENZA MARC 48 HOWE ST NEW HAVEN CT 06511-4620 860-560-6396

HUSKY Health Connecticut Page 46 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 47: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1639689060 POTHIER SARAH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1427149798 POTLER ANDREW 780 MAIN ST., STE.1 GREAT BARRINGTON MA 01230-2180 413-528-2418

1609841097 POTTER MELISSA 67 BELMONT STREET WORCESTER MA 01605-2903 508-334-8152

1013000918 POURESMAIL MEHRAN 19 CENTERVIEW RD WOODBRIDGE CT 06525-1842 203-298-0724

1699061077 POWERS KATE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1730248485 POWERS RICHARD 205 MAIN STREET EAST HAVEN CT 06512-3003 203-877-0112

1770590929 PRESS JOEL 535 E 70 ST HOSPITAL FOR SPECIAL SURGERY NEW YORK NY 10021-4823 212-774-7598

1407940521 PRESSON YUNIKA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9132

1124385463 PRICE DANA 223 EAST 34TH STREET NEW YORK NY 10016-4852 516-663-3018

1104891407 PRICE RICHARD 441 ROUTE 306 ST 3 MONSEY NY 10952-1234 845-893-4538

1720424567 PRIETO DIANA 263 FARMINGTON AVE MC 1410 FARMINGTON CT 06030-1921 860-679-2730

1912488222 PRIOR MAXWELL 11 WILBRAHAM ROAD SPRINGFIELD MA 01109-3161 413-794-3710

1649518481 PRIYAWAT NUPPORN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1922197896 PROTA CARL 1367 NORTH HIGH STREET EAST HAVEN CT 06512-1121 203-468-8007

1063987030 PROVOST ASHLEY 759 CHESTNUT STREET 2ND FLOOR SPRINGFIELD MA 01107-1619 413-794-8020

1932563590 PUJARA MIHEER 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1184902967 PURDELL JENNA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 802-370-4715

1063469724 PUREWAL AMARPAL 530 NEW BRUNSWICK AVE PERTH AMBOY NJ 08861-3654 800-645-3055

1457407744 PURVIANCE KEVIN 61 SOUTH MAIN ST SUITE 301 WEST HARTFORD CT 06107-2486 860-236-2566

1184093163 PUTHENPURA VIDYA 333 CEDAR STREET LMP 2073 NEW HAVEN CT 06520-8064 203-785-4011

1194899286 PUTNAM ADAM 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661-8973 508-482-9600

1396185328 QAJA ERION 80 SEYMOUR STREET HARTFORD CT 06102-5037 860-972-2840

1558519678 QUATINETZ LARA 800 CROSS RIVER ROAD KATONAH NY 10536-0800 914-763-8151

1609928704 QUATROCELLI STEPHEN 360 TOLLAND TPKE., SUITE 2A MANCHESTER CT 06042-1770 860-646-4811

1831303106 QURESHI SHEERAZ 535 E 70TH ST NEW YORK NY 10021-4823 212-774-7598

1023480829 RADI NICOLE 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-221-0791

1942290010 RADLER ERIC 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1235615006 RADWAN MOHAMED SAMEH 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1104186089 RAFFERTY JASON 1 HOPPIN STREET STE 204 PROVIDENCE RI 02903-4141 401-444-8945

1598044133 RAJANNA CHAMPAKAMALA 189 STORRS ROAD MANSFIELD CENTER CT 06250-1683 860-465-5906

1124281332 RAMIREZ RICHMOND 186 PROVIDENCE STREET THUNDERMIST HEALTH CENTER WEST WARWICK RI 02893-2508 401-767-4100

1306873468 RANA ALPANA 555 WILLARD AVE VA MEDICAL CENTER NEWINGTON CT 06111-2631 860-666-6951

1053407304 RANA SUNIL 49 LAKE AVE, STE 2 GREENWICH CT 06830-4501 203-869-7704

1134131766 RANAWAT AMAR 535 E 70 ST HOSPITAL FOR SPECIAL SURGERY NEW YORK NY 10021-4823 212-744-7598

1912955188 RANDALL REBECCA 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-921-7566

1902213879 RANJITKAR PARAS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1518182476 RANNEY MEGAN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1982969416 RAO SHYAM 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6788

1144489543 RAO SUPARNA 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1285026997 RAPPENO JESSICA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 802-236-5016

1679915110 RASHID ALI ABBAS 20 YORK STREET YNHH DEPT OF NEUROLOGY NEW HAVEN CT 06510-3220 203-688-9503

1265415152 RATHER MANZOOR 1500 LANSDOWNE AVE DARBY PA 19023-1291 623-582-2141

1972704245 RATHI AMIT 345 N MAIN ST SUITE 311 WEST HARTFORD CT 06117-2508 860-707-3502

1184848558 RATHIER LUCILLE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9864

1528006038 RAU GREGORY 134 PARK STREET NEW HAVEN CT 06511-5409 203-865-6143

HUSKY Health Connecticut Page 47 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 48: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1427053701 RAVIN ANATOLIY 85 SEYMOUR STREET SUITE 922 SUITE 922 HARTFORD CT 06106-1118 860-790-0260

1255593943 RAVINDRAN LAKSHMI 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1417300203 RAVINDRANATH WAIKAR APOORVA 330 CEDAR STREET YNHH PEDIATRICS NEW HAVEN CT 06519-3218 203-737-6905

1063523017 RAWLINS BERNARD 535 E. 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1285624353 RAY ELLEN 242 GREEN STREET GARDNER MA 01440-1336 508-482-9600

1659527851 RAYMOND MARIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1194793018 RAYNER JAMES 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1851417620 RAYNOR MATTHEW 1022 STORRS ROAD STORRS CT 06268-2639 860-429-6406

1689027542 RAYTA NICOLE 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 401-692-9408

1609027697 RAZA SAKEENA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1245288026 READER CLAUDIO 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1841418944 REAGAN JOHN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1558336669 REALI-MARINI DIANE 455 TOLLGATE ROAD WARWICK RI 02886-2759 401-273-0641

1790869691 REARDON DAVID 450 BROOKLINE AVENUE BOSTON MA 02215-5418 508-482-9600

1528454196 REARDON JULIANN 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1073539813 REBEIRO KATHY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-5700

1750458949 RECTOR FRANKLIN CTR PATRICK F. MCAULIFFE CENTE 70 CENTRAL AVE WATERBURY CT 06702-1207 203-346-1931

1508015959 REED DAVID ONE HOSPITAL PLAZA STAMFORD CT 06904-9317 203-276-5548

1912946195 REED DONNA 100 CENTURY DRIVE WORCESTER MA 01606-1244 508-334-6173

1750470241 REED KAREN 13681 DOCTORS WAY FORT MYERS FL 33912-4309 800-645-3055

1013989425 REGAN FORD SARA 1 HOPPIN STREET SUITE 304 PROVIDENCE RI 02903-4141 401-444-4612

1194080036 REICH ERIK 303 SOUTH BROAD STREET MERIDEN CT 06450-6646 203-877-0112

1861421208 REICHLER BRION 535 E. 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1295184059 REILLY VANESSA 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1073821187 REISCHERL ANDREA 24 WOLCOTT HILL ROAD WETHERSFIELD CT 06109-1152 860-692-6807

1083625123 REITMEYER GINA 25 CHURCH HILL ROAD SUITE 102 NEWTOWN CT 06470-2122 203-743-9539

1285809319 REMIGIO-MANDAC JENNIFER 500 ENTERPRISE DR ROCKY HILL CT 06067-3913 615-224-5005

1952337040 REMZI FEZA 530 FIRST AVE SUITE 7V NEW YORK NY 10016-6402 516-663-2818

1447304605 RENAUD THOMAS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5241

1205947306 RESOR STANLEY 159 WEST PUTNAM AVE GREENWICH CT 06830-5329 203-987-3117

1255510913 RESSLER ILANA 100 TECHNOLOGY DRIVE SUITE 210 TRUMBULL CT 06611-6303 203-880-5416

1457464968 RHORER JAMES 5000 HENNESSY BLVD. BATON ROUGE LA 70808-4375 800-645-3055

1467613554 RICCARDELLI WILLIAM 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1104189653 RICE DONALD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-3055

1093808727 RICHARDSON ELBERT 234 CHURCH ST SUITE NEW HAVEN CT 06510-1804 203-215-7472

1619200599 RICK ANDREA 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-7089

1912472093 RICKEVICIUS SOPHIA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-689-3919

1548445281 RIDEOUT JESSE 800 WASHINGTON STREET BOSTON MA 02111-1552 904-421-1983

1508839630 RIDLEY STEPHEN 5 RICHLAND MEDICAL PARK COLUMBIA SC 29203-6863 888-851-7590

1871535500 RIECKER WILLIAM 2261 BROADBRIDGE AVENUE STRATFORD CT 06614-3860 203-375-4633

1972847069 RIERA ROSA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1649408725 RIESE JEFFREY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-7396

1043347537 RIVAS JAIME 220 WESTCHESTER AVE PORT CHESTER NY 10573-4558 914-939-6696

1194818013 RIXON JOHN 55 WEBSTER HILL BLVD WEST HARTFORD CT 06107-3458 860-561-7131

1851419014 RIZEN BRIAN 515, ROUTE 413 WOODS SERVICES LANGHORNE PA 19047-0036 215-750-4212

HUSKY Health Connecticut Page 48 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 49: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1457345605 RO HOWARD 701 ENFIELD STREET ENFIELD MEDICAL ASSOCIATES ENFIELD CT 06082-2961 860-741-6572

1811937907 ROACH RACHEL 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 401-742-8077

1497041149 ROBB VANESSA 51 MARKET SQUARE NEWINGTON CT 06111-1902 860-667-0818

1477665420 ROBBINS MICHAEL 1 LONG WHARF DR STE 212 NEW HAVEN CT 06511-5593 203-624-4208

1881853521 ROBERTS CATHERINE 55 LOCK ST. MENTAL HEALTH AND COUNSELING NEW HAVEN CT 06511-8237 203-432-0290

1306853262 ROBERTS MATTHEW 535 E. 70TH ST NEW YORK NY 10021-4823 626-797-8471

1508108911 ROBICHAUX BENJAMIN 195 EASTERN BLVD SUITE 200 GLASTONBURY CT 06033-1208 860-781-6294

1457713638 ROBINSON ERICA 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1124256722 ROBINSON SPENCER 5 RICHLAND MEDICAL PARK COLUMBIA SC 29203-6897 803-296-7998

1346656824 ROBISON JEREMIAH 4422 3RD AVE BRONX NY 10457-2545 800-645-3055

1376633248 ROBISON KATINA 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1437350642 ROCKWELL MICHELLE 620 BYRON ROAD HOWELL MI 48843-1002 734-343-0396

1407871338 RODEO SCOTT 535 E 70 ST HOSPITAL FOR SPECIAL SURGERY NEW YORK NY 10021-4823 212-774-7598

1831151281 RODRIGUEZ ALCIBIADES 223 E 34TH ST NEW YORK NY 10016-4852 512-767-6140

1497706519 RODRIGUEZ DE LEON OSCAR 725 NORTH STREET PITTSFIELD MA 01201-4124 413-447-2752

1275945115 RODWIN ROZALYN 20 YORK STREET YNHH PEDIATRIC HEMATOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1992064323 ROGERS ANDREW 1924 ALCOA HWY KNOXVILLE TN 37920-1511 800-645-3055

1861465973 ROGERS HOWARD 111 SALEM TPKE STE 7 NORWICH CT 06360-7403 860-859-2262

1932113073 ROHR MICHELE 159 WEST PUTNAM AVENUE GREENWICH CT 06830-5329 203-869-7080

1255313490 ROLOFF CHRISTOPHER 211 PARK STREET ATTLEBORO MA 02703-3143 508-482-9600

1942493101 ROMEE RIZWAN DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-6140

1750894507 ROSA LAUREN 395 PLEASANT STREET NORTHAMPTON MA 01060-3914 413-584-7787

1679543680 ROSE ARON 6 BUSINESS PARK DRIVE SUITE 102 BRANFORD CT 06405-2988 203-573-4803

1407175078 ROSEN EVAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1023118999 ROSENBERG ILENE 40 COMMERCE PARK SUITE 1 MILFORD CT 06460-3506 203-878-3531

1932204203 ROSENBERG REMI 5 HIGH RIDGE PARK SUITE 103 STAMFORD CT 06905-1326 203-276-2182

1154411817 ROSENHEIN BRUCE 725 NORTH STREET PITTSFIELD MA 01201-4019 413-881-5427

1730100546 ROSENKRANZ BARRY 55 CHURCH ST.SUITE 403 YALE BEHAVIORAL HEALTH NEW HAVEN CT 06510-3014 203-764-7276

1710935788 ROSENTHAL BARRY 259 FIRST STREET MINEOLA NY 11501-3957 516-663-2727

1972730653 ROSENTHAL DAVID VA CONNECTICUT 950 CAMPBELL AVENUE WEST HAVEN CT 06516-2770 203-932-5711

1609877448 ROSIN BENJAMIN 14502 W MEEKER BLVD SUN CITY WEST AZ 85375-5282 385-695-1936

1629016407 ROSS IV ALBERT 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8306

1164950143 ROSSATOBENNETT XIMENA 94 LOCUST AVENUE DANBURY CT 06810-5954 203-798-0500

1275976052 ROSSIGNOL JOHN 36 EAST MAIN STREET AVON CT 06001-3801 860-677-5533

1538272117 ROSTENBERG PETER 71 ROUTE 39 NEW FAIRFIELD CT 06812-4017 203-746-3300

1972570422 ROTONDO KATHLEEN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1447488549 ROUGAS STEVEN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1295174373 ROWLAND EMILY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-845-1998

1346698065 ROWLES ANDREW 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1376749259 ROY SOUMEN 250 PLEASANT STREET CONCORD NH 03301-7539 603-227-7000

1295741403 ROZENFELD RANNA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1245775717 ROZENTSVIT ARTUR 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1306997291 RUAN LILY 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 917-282-8958

1578593497 RUBEN HARVEY 77 KNOLLWOOD DRIVE NEW HAVEN CT 06515-9998 203-397-0064

1003934233 RUBIN TODD 469 BUCKLAND RD SOUTH WINDSOR CT 06074-3737 860-644-2136

HUSKY Health Connecticut Page 49 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 50: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1528067766 RUBINSTEIN STEVE 910 E BOSTON POST RD MAMARONECK NY 10543-4109 914-835-6990

1023102910 RUCHO MARY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1598927634 RUDICH DANIELLE 1201 W. MAIN ST SUITE 100 WATERBURY CT 06708-4926 203-573-4803

1114213683 RUEST STEPHANIE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1649445917 RUETH NATASHA 800 E 28TH ST MINNEAPOLIS MN 55407-3723 612-262-3851

1275799827 RUIZ VALCARCEL CARMEN 3000 CORAL HILLS DR CORAL SPRINGS FL 33065-4108 623-580-6309

1649583782 RUPAWALA ABBAS 245 CHAPMAN STREET SUITE 300 PROVIDENCE RI 02905-4539 401-444-4741

1508841388 RUSCH VALERIE 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1467402693 RUSHIN RANDALL 20-30 BEAVER ROAD SUITE 102 WETHERSFIELD CT 06109-2242 860-721-7428

1801319785 RUSSELL CAELI 759 CHESTNUT STREET 2ND FLOOR SPRINGFIELD MA 01107-1612 413-794-3233

1689672347 RUSSELL DONNA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1740628106 RUSSELL MELISSA 223 E 34TH ST 9TH FLOOR-CREDENTIALING NEW YORK NY 10016-4852 512-767-6140

1356622120 RUSSELL SAMARA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-772-2135

1891762837 RUSSO MICHAEL 400 WEST MAIN STREET BRANFORD CT 06405-3416 203-483-7778

1821000613 SABERSKI LLOYD 1 LONG WHARF DR STE 212 NEW HAVEN CT 06511-5593 203-624-4208

1942341060 SABOVIC ZIJAD 3000 PARK AVE BR CT 06604-1105 203-331-8704

1619924750 SABRA MONA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1013371665 SACCARY ABBIE 464 CONGRESS AVENUE YNHH EMERGENCY DEPARTMENT NEW HAVEN CT 06519-1361 203-909-7950

1548522022 SADANA KRISTEN 7 KENOSIA AVE 1ST FLOOR DANBURY CT 06810-3040 203-546-3414

1427308105 SADANOWICZ ALEXANDRA 163 BROADWAY STREET COLCHESTER CT 06415-1022 860-537-2020

1346748977 SADLER DEVIN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-606-1160

1235209347 SAEED AYSHA 555 WILLARD AVENUE NEWINGTON CT 06111-2631 860-666-6951

1538213483 SAKR BACHIR 101 DUDLEY ST PROVIDENCE RI 02905-2401 401-921-7362

1558306225 SALAHUDDIN KAZI 2180 MEDON ROAD SUITE 21 CUMBERLAND RI 02864-3842 401-333-3810

1386686772 SALANI VARSHA 10 BROADWAY NORTH HAVEN CT 06473-2301 203-234-1901

1154663300 SALUJA SANDEEP 999 SUMMER STREET STE 305 STAMFORD CT 06905-5546 203-428-4440

1235239526 SAMAAN FADI 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1508843988 SANDHU JASPREET 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1568425171 SANDLER JEFFREY 4699 MAIN STREET SUITE 106 BRIDGEPORT CT 06606-1830 203-374-8182

1811252026 SANDOVAL-GONZALEZ JUAN 450 S. OCOTILLO AVE BENSON AZ 85602-6403 800-645-3055

1245557289 SANFORD RACHEL 300 WESTCHESTER AVE MSK HARRISON WEST HARRISON NY 10604-6007 646-227-3742

1700225703 SANGHA MAHEEP 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1932477585 SANJURJO TOMAS 290 ROBERTS STREET 2ND FLOOR EAST HARTFORD CT 06108-3684 860-826-4763

1629389994 SANTILLE REBECCA 455 TOLL GATE RD WARWICK RI 02886-9252 401-273-0641

1154450526 SANTORELLA JOHN 20 NORTH MAIN STREET NORWALK CT 06854-2656 203-866-6658

1316280639 SANTOS MICHAEL 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1336450261 SARASIN MATTHEW 111 BREWSTER STREET PAWTUCKET RI 02860-4474 401-273-0641

1235154410 SARFEH JAMES 556 BUSK CT CHESHIRE CT 06410-4155 203-217-3359

1235576380 SARFRAZ SYLVESTER 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1760466536 SATCHELL JACQUELINE 950 CAMPBELL AVENUE VA MEDICAL CENTER, PRIMARY CAR WEST HAVEN CT 06516-2700 203-932-5711

1770611717 SATINOVER JEFFREY 7 KENOSIA AVE DANBURY CT 06810-7395 475-329-2677

1134365976 SAUER KERRI 150 WARE RD DAYVILLE CT 06241-1126 860-774-8574

1013078260 SAUNDERS LORRAINE 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1447494612 SAUTER CRAIG 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

HUSKY Health Connecticut Page 50 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 51: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1295732444 SAUTER JOHN 600 ST JOHNSBURY ROAD LITTLETON NH 03561-3442 603-444-9271

1144774597 SAVARESE KATHRYN 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1164873600 SAWYER KARA 701 ENFIELD STREET ENFIELD CT 06082-2967 860-741-6572

1629448378 SAYLOR CHELSEA 5300 KIDSPEACE DRIVE OREFIELD PA 18069-2044 610-799-8853

1942477740 SCARFO CARLA 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-606-3000

1679545396 SCHAAR THOMAS 13681 DOCTORS WAY FORT MYERS FL 33912-4309 800-645-3055

1467794537 SCHAIRER WILLIAM 535 EAST 70TH STREET NEW YORK NY 10021-4823 212-774-7598

1669603049 SCHALET KARYN 3400 MAIN STREET SPRINGFIELD MA 01107-1113 413-794-9560

1841458759 SCHAMBERG NEAL 15 VALLEY DRIVE 3RD FLOOR GREENWICH CT 06831-5205 203-489-6900

1225047772 SCHECHTER JADE 21 E 4TH STREET, 7 FL NEW YORK NY 10003-7012 302-313-1584

1689942559 SCHEINBERG KATHLEEN 327 HIGH STREET MIDDLETOWN CT 06459-3232 860-757-3035

1215202353 SCHINDLER EMMANUELLE 950 CAMPBELL AVENUE MS 127 WEST HAVEN CT 06512-2770 203-932-5711

1487134284 SCHLOSKY AMANDA 2 MEDICAL CENTER DRIVE SUITE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1497809784 SCHLUSSEL RICHARD 1999 MARCUS AVE STE M18 NEW HYDE PARK NY 11042-1023 914-962-8290

1316993975 SCHMITT PHILIP 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-845-1473

1447201405 SCHNEIDER JEFFREY 259 1ST STREET MINEOLA NY 11501-3957 516-663-4941

1174941744 SCHNEIDER MARABEL 333 CEDAR STREET YALE CARDIOVASCULAR MEDICINE NEW HAVEN CT 06520-8017 203-737-4026

1497843197 SCHNEIDER MARCIE 239 GLENVILLE ROAD GREENWICH ADOLESCENT MEDICINE GREENWICH CT 06831-4172 203-532-1919

1184798852 SCHNEIDER OWEN 52 BEACH RD FAIRFIELD CT 06824-6017 203-254-2000

1366601213 SCHNEIDER ROBERT 72 DALTON RD MILFORD CT 06460-6908 203-226-6655

1982776340 SCHOEN MARY 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3813

1134612294 SCHONHOFT ELIZABETH 200 WEST ARBOR DRIVE SAN DIEGO CA 92103-8937 918-203-0114

1598772766 SCHRAGER ALAN 1600 HARRISON AVENUE G102 MAMARONECK NY 10543-3145 914-698-8106

1528065984 SCHREIBER JONATHAN 1 BARNARD LN STE 102 SUITE 102 BLOOMFIELD CT 06002-2482 860-243-1889

1134129109 SCHUMAKER JEAN 2 MEDICAL CENTER DRIVE STE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1912091760 SCHWARTZ AMY 950 CAMPBELL AVE 11ACSL WEST HAVEN CT 06516-2770 866-808-7921

1750369625 SCHWARTZ MIRIAM 836 FARMINGTON AVE, SUITE 221B WEST HARTFORD CT 06119-1505 860-995-0432

1003115700 SCORDO MICHAEL 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1063438547 SCOTT MARK 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-921-7566

1891844080 SCOTTO JAMISON 1080 DAY HILL ROAD WINDSOR CT 06095-1781 860-683-0243

1417085465 SCULLY MARY 1125 NEW BRITAIN AVE WEST HARTFORD CT 06110-2420 860-561-3345

1073619391 SEDIVA IVONA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4201

1023472701 SEELIG SANDRA 20 YORK STREET YNHH EMERGENCY MEDICINE NEW HAVEN CT 06510-3220 203-688-9503

1912972548 SEEWALD RANDY 30 MILESTONE ROAD DANBURY CT 06810-5114 203-456-8353

1508889197 SEIDNER JACOB 70 WASHINGTON AVE NORTH HAVEN CT 06473-1703 203-530-1419

1447416086 SEIGEL JAY 24 CHANNING ST NEW LONDON CT 06320-5735 203-303-7387

1306055116 SEIMS AARON 92 W. MILLER ST ORLANDO FL 32806-2032 800-645-3055

1215370010 SEKAR KRITHIGA 223 EAST 34TH STREET NEW YORK NY 10016-4852 516-663-3018

1508912759 SELKIN ALAN 15 VALLEY DRIVE 3RD FLOOR GREENWICH CT 06831-5205 203-489-6900

1780747840 SEPLOWITZ BRUCE 60 ALGER RD EAST HADDAM CT 06423-1212 860-873-1777

1982867578 SEQUEIRA SHWETHA ONE BOSTON MEDICAL CENTER PL BOSTON MA 02118-2908 617-414-6033

1750344800 SERGEL SHEILA 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1740589233 SERRANO GONZALEZ MONICA 1 HOPPIN STREET SUITE 3.055 PROVIDENCE RI 02903-4141 401-444-5980

1518202944 SHACKELFORD JENNIFER 55 FRUIT ST BOSTON MA 02114-2696 617-643-2443

HUSKY Health Connecticut Page 51 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 52: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1831197433 SHAFI MOHAMMAD 907 E. LAMAR ALEXANDER PKWY MARYVILLE TN 37804-5015 800-645-3055

1871796243 SHAFIE SHIDEH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6779

1053586263 SHAH GUNJAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1891010476 SHAH NISHAN 206 SECOND STREET EAST BRADENTON FL 34202-1253 941-746-5111

1790075752 SHAHRIARI MONA UCONN MEDICAL GROUP 21 SOUTH ROAD FARMINGTON CT 06032-0001 860-679-3474

1366497679 SHALON LINDA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6195

1295805927 SHAMSI RAHIM 60 WESTWOOD AVENUE WATERBURY CT 06708-2460 203-753-6160

1912387804 SHANKAR NIKHIL 200 MILL ROAD SUITE 160 FAIRHAVEN MA 02719-5208 508-973-3584

1255399358 SHAPIRO JULIE 55 FOGG ROAD SOUTH WEYMOUTH MA 02190-2432 781-792-4136

1255352738 SHARAF BARRY 164 SUMMIT AVENUE PROVIDENCE RI 02906-3902 401-793-2500

1659787125 SHARMA ANJALI 80 SEYMOUR ST HARTFORD CT 06102-5037 860-679-4763

1871646836 SHARNICK MAUREEN 375 BRIDGEPORT AVE SHELTON CT 06484-3844 203-925-8510

1184796484 SHAW STEVEN 136 WEST MAIN STREET FIRST FLOOR NEW BRITAIN CT 06051-1315 860-826-4763

1053743286 SHAWN MARSH SAMANTHA 85 BEACH STREET BLDG C, UNIT 8 WESTERLY RI 02891-2718 401-348-2800

1710974530 SHEA JUDITH 7 RIVERSVILLE ROAD GREENWICH CT 06831-3684 203-531-1808

1649729096 SHEEHAN PAC LISA 761 MAIN AVE SUITE 102 NORWALK CT 06851-0001 860-282-4128

1568540789 SHEINTOP DAVID 256 NORTH MAIN ST SOUTHINGTON CT 06489-2524 860-276-0225

1164485306 SHEN JIAN 5010 STHWY 30 SUITE 205 AMSTERDAM NY 12010-7532 518-773-4242

1083794812 SHENDER ANNA 66 GLENBROOK RD STAMFORD CT 06902-8402 203-961-8241

1639144090 SHERRILL CHERYL 281 LINCOLN STREET WORCESTER MA 01605-2138 508-334-8152

1467642272 SHETTY KARTIKA 102 E LAKE MEAD PKWY HENDERSRON NV 89015-5575 800-633-2243

1013192384 SHETTY SAFAL 163 UNIVERSAL DRIVE NORTH NORTH HAVEN CT 06473-3152 203-523-0971

1578506622 SHETTY TEENA 535 EAST 70TH ST. NEW YORK NY 10021-4823 646-797-8471

1629168059 SHEVIN WILLIAM 50 APPLEWOOD DRIVE WOODSTOCK CT 06281-2304 860-928-4040

1710144415 SHIFREEN JULIE 645 FARMINGTON AVENUE HARTFORD CT 06105-2946 860-570-3400

1871663328 SHIFREEN STEVEN 645 FARMINGTON AVENUE HARTFORD CT 06105-8705 860-570-3400

1699054924 SHIMANOVSKY ALEXEI 593 EDDY STREET STE 101 PROVIDENCE RI 02903-4923 401-444-6779

1366932188 SHIROKOVA MARINA 2 MEDICAL CENTER DRIVE STE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1972604528 SHITIA HUSAM 430 HIGHLAND AVE CHESHIRE CT 06410-2565 203-271-3132

1568452159 SHOLOMSKAS ALAN 2440 WHITNEY AVE HAMDEN CT 06518-3222 203-776-2077

1366707689 SHRESTHA RAJESH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1205165610 SHRESTHA SHIKHA 13681 DOCTORS WAY FORT MYERS FL 33912-4309 800-645-3055

1982871612 SHTILBANS ALEXANDER 535 EAST 70TH STREET NEW YORK NY 10021-4823 646-797-8471

1073557724 SHULER WESLEY 2720 SUNSET BLVD WEST COLUMBIA SC 29169-4810 888-851-7590

1124361886 SHUM JENNIFER 223 EAST 34TH STREET NEW YORK NY 10016-4852 516-663-8798

1861593873 SIAZON-LEVISTE CATHERINE 1000 SILVER STREET MIDDLETOWN CT 06457-7203 860-262-5000

1518515766 SIBAI AMANDA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1669668729 SIBBALD JESSICA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1144360629 SICA ROBBAN 1 TURKEY HILL ROAD SOUTH WESTPORT CT 06880-3534 203-799-7733

1285969980 SIDDIQUI IQBAL 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1265438923 SIEDLECKI DIANE 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1497922645 SIEGEL CYNTHIA 146 WEST RIVER STREET SUITE 11 C PROVIDENCE RI 02904-2626 401-606-3000

1891897377 SIEGER BRENT 301 MEMORIAL MEDICAL PKWY DAYTONA BEACH FL 32117-5167 800-645-3055

1992117584 SIEGER KEITH 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1134388432 SIKAND JENNIFER 102 E LAKE MEAD PKWY HENDERSON NV 89015-5575 800-633-2243

HUSKY Health Connecticut Page 52 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 53: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1013914167 SIKAND VIJAY 7 VAUXHALL ST NEW LONDON CT 06320-5711 860-443-2896

1477523496 SILBERT JONATHAN 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1669528311 SILVA LEE TRACY 1275 SUMMER STREET SUITE 105 STAMFORD CT 06905-5315 203-325-2667

1598860769 SILVI PAUL 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

1063832319 SILVIS JENNIFER 263 FARMINGTON AVE FARMINGTON CT 06030-1921 860-972-4069

1811068398 SIMMONS DONNA 703 MAIN STREET PATERSON NJ 07503-3079 973-754-2956

1871883942 SIMMONS MOLLIE 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1871903187 SIMMONS TAYLOR 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1740640739 SIMMS NICHOLAS 3400 MAIN STREET SPRINGFIELD MA 01107-1113 413-794-9560

1316057409 SIMOES MEERA 900 WARREN AVENUE SUITE 101 EAST PROVIDENCE RI 02914-1430 401-919-5200

1851385058 SIMON EDDY 65 JAMES STREET EDISON NJ 08820-3947 800-645-3055

1124043518 SIMONS SANDRA 1500 NORTH 28TH ST RICHMOND VA 23223-5332 804-627-5573

1689601080 SIMPSON HAROLD 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1114956661 SINGH AKHILESH 555 WILLARD AVE VA MEDICAL CENTER NEWINGTON CT 06111-2631 860-666-6951

1225354103 SINGH JASMEET 500 WESTCHESTER AVE MSK HARRISON WEST HARRISON NY 10604-6007 646-227-3742

1386602175 SINGH KABUL 43-73 UNION STREET SUITE CA FLUSHING NY 11355-3191 718-460-9395

1922340413 SINGH MAURA 20 YORK STREET YNHH GERIATRIC MEDICINE NEW HAVEN CT 06510-3220 203-688-9503

1952618720 SINGLETON MARISA 189 STORRS ROAD MANSFIELD CENTER CT 06250-1683 860-456-1311

1154402378 SINGLETON STACIE 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

1225393432 SISMANOPOULOS NIKOLAOS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1306152632 SKEEHAN CHRISTOPHER 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-444-6779

1215907225 SKLAR CRAIG 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1063738722 SKRUCK BERNADETTE 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

1083909097 SLEDGE ALBERT 181 MAIN ST NORWAY ME 04268-5664 207-744-6106

1841610664 SLOSHOWER JORDAN 300 GEORGE STREET YALE PSYCHIATRY NEW HAVEN CT 06511-6663 203-785-2095

1497140305 SMERKERS BRIAN 1 BOSTON MEDICAL CENTER PLACE BOSTON MA 02118-2908 617-414-7399

1063421329 SMITH ANGELA 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1760512966 SMITH BLAKE 888 SOUTH KING STREET HONOLULU HI 96813-3097 800-645-3055

1194277558 SMITH BRENDAN 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-441-6767

1518995059 SMITH DAVID 55 LOCK STREET NEW HAVEN CT 06511-3603 203-432-0076

1740571256 SMITH EDWARD 1600 S ANDREWS AVE FORT LAUDERDALE FL 33316-2510 954-847-4572

1528226750 SMITH ELIZABETH 1305 POST ROAD SUITE 310 FAIRFIELD CT 06824-6018 203-259-7709

1881761260 SMITH JOANN 1261 POST ROAD SUITE 200 - A FAIRFIELD CT 06824-6072 203-255-0770

1194773093 SMITH MELINDA 555 WILLARD AVE NEWINGTON CT 06111-2631 860-666-6951

1790915031 SMITH MELODY 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1396211991 SMITH QUENTIN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1336187657 SMITH RICHARD 1101 NOTT ST SCHENECTADY NY 12308-2425 801-256-1900

1578923231 SMITH SEAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1669714788 SMITH STEPHEN 310 CEDAR STREET YUSM PATHOLOGY DEPT NEW HAVEN CT 06520-8070 203-688-9503

1366451155 SMITH THOMAS ONE TURKEY HILL ROAD SOUTH WESTPORT CT 06880-2621 646-737-2687

1982634267 SNEDIKER DANIEL 3100 EAST FLETCHER AVE. TAMPA FL 33613-4613 800-645-3055

1134174592 SNELLING LINDA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4201

1447342183 SNOW KEVIN CAREONE AT HOLYOKE 260 EASTHAMPTON RD HOLYOKE MA 01040-1213 413-538-9733

1003916974 SNYDER CHRISTOPHER 40 COMMERCE PARK SUITE 1 MILFORD CT 06460-3506 203-878-3531

HUSKY Health Connecticut Page 53 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 54: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1467748111 SO SOKPOLEAK 67 SANDPIT RD SUITE 308 DANBURY CT 06810-4032 631-445-0593

1104958438 SOBIERAJ WADHWA CHERYL 650 CHASE PARKWAY WATERBURY CT 06708-3046 203-597-8878

1609849728 SOCHA CHRISTY 111 SALEM TURNPIKE SUITE 7 NORWICH CT 06360-6459 860-859-2262

1538235791 SOLLINGER JONATHAN 1563 POST ROAD EAST WESTPORT CT 06880-5602 203-319-3939

1144257445 SOLOF GREGORY 20 WEST AVON RD AVON CT 06001-3540 860-673-0451

1710933460 SOLOMON GARY 698 WEST AVE REHABILITATION CONSULTS PC NORWALK CT 06850-3302 203-523-0100

1457699431 SONG YOUNG 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1588652358 SOOD PARDEEP 5520 PARK AVENUE SUITE 303 TRUMBULL CT 06611-9999 410-329-1071

1487680831 SOOVAJIAN VICTORIA 149 HOLLAND LANE EAST HARTFORD CT 06118-1968 860-810-2777

1669575403 SORDO SARAH 750 BRUNSWICK AVENUE TRENTON NJ 08638-4143 609-815-7829

1194840272 SOUDER CHRISTOPHER 3790 E. WOODMEN RD COLORADO SPRINGS CO 80920-4139 800-645-3055

1891757738 SOWKA WILLIAM 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1407956378 SPANOLIOS PARIS 40 COMMERCE PARK SUITE 1 MILFORD CT 06460-3506 203-878-3531

1700038858 SPARTA KHRISTINE 1881 POST RD FAIRFIELD CT 06824-5721 203-255-1036

1093816175 SPECTOR GARY 40 COMMERCE PARK SUITE 1 MILFORD CT 06460-3506 203-878-3531

1215950662 SPELMAN JULIETTE 950 CAMPBELL AVENUE 11ACSL WEST HAVEN CT 06516-2770 866-808-7921

1568982353 SPENCER JEFFREY 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1457447757 SPINELLI HENRY 875 5TH AVE NEW YORK NY 10065-4952 212-570-6235

1396702205 SPITALNIC STUART 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1124164777 SPITZER MAUREEN 15 CHESTERFIELD ROAD SUITE 212 EAST LYME CT 06333-1736 860-739-5557

1962439380 SPIVACK ADAM VA MEDICAL CENTER 555 WILLARD AVE., 3RD FL., MHC NEWINGTON CT 06111-2631 860-666-6951

1780775577 SPROVIERO JOSEPH 148 EAST AVENUE STE 3G NORWALK CT 06851-5727 203-838-4034

1649596172 ST AMAND CHRISTOPHER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1245380575 ST JEAN KAREN 920 BROAD STREET HARTFORD CT 06260-2826 860-244-7960

1386612828 STALEY DEBORAH 231 MERROW ROAD MANCHESTER PEDIATRIC ASSOCIATE TOLLAND CT 06084-3915 860-875-9856

1780651919 STAMBAUGH ROBERT 736 N BATTLEFIELD BLVD CHESAPEAKE VA 23320-4941 800-633-2243

1427542877 STANKO MARTHA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1619395449 STANLEY GAIL 20 YORK STREET NEW HAVEN CT 06510-3202 203-688-4242

1669436820 STARK JACK 132 MAIN ST DANBURY CT 06810-7863 203-794-1979

1760658264 STARKS JAMES 521 WEST 57TH STREET-4TH FLR NEW YORK NY 10019-2929 646-557-3847

1225180771 STARR CAROL 41 NORTH MAIN STREET SUITE 208 WEST HARTFORD CT 06107-1929 860-313-0818

1699737536 STAWIECKI JEANNE 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1659539666 STCYR NICOLE 136 WEST MAIN STREET FIRST FLOOR NEW BRITAIN CT 06051-1315 860-826-4763

1033125166 STEELE DALE 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1356576516 STEELE DANIEL 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

1255689808 STEFANIK JENNIFER DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5450 617-632-2166

1114100047 STEIN EYTAN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1033371984 STEIN JULIE 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2752

1609904960 STEIN SANDERS 2777 SUMMER ST SUITE 504B STAMFORD CT 06905-4318 203-324-0082

1962437871 STEINBERG JEREMY 593 EDDY STREET PROVIDENCE RI 02903-4923 401-793-9166

1417069543 STEINHARDT MINDI 397 BRIDGEPORT AVE MILFORD CT 06460-4151 203-877-0112

1740215961 STEINMETZ JOHN 680 CENTRE STREET BROCKTON MA 02302-3308 508-941-0959

1093771404 STENGEL CHARLES 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-854-2504

1053370379 STEPHAN LAHAM MARIA 5801 BREMO ROAD RICHMOND VA 23226-1907 804-627-5573

HUSKY Health Connecticut Page 54 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 55: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1013369446 STERIADE CLAUDE 223 E. 34TH ST NEW YORK NY 10016-4852 516-663-2818

1821085382 STERLING ROBERT 120 EAST AVENUE SUITE 1 E NORWALK CT 06851-5703 203-410-6957

1235421181 STEVENS AMY 25 IMPERIAL AVE. WESTPORT CT 06880-4303 203-645-4562

1942711718 STEVENS ASHLEY 23 CEDAR STREET NEW BRITAIN CT 06052-1301 860-259-6952

1528185212 STEWART SARAH 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1134558067 STILES SHELBY 140 ACADEMY STREET PRESQUE ISLE ME 04769-3102 800-645-3055

1649287665 STITELMAN MICHAEL 155 MEADOW ST BRANFORD CT 06405-3656 203-481-4637

1619497740 STOGSDILL ALICIA 801 N. LINCOLN AVE. MONETT MO 65708-6141 417-450-2420

1477034866 STONE CRISTINA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 203-645-8339

1528036894 STONE RICHARD 450 BROOKLINE AVENUE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5917

1346256831 STONER JASON 489 STATE ST. BANGOR ME 04401-6616 800-645-3055

1477524700 STOUT VICTORIA 501 STUDENT HEALTH CENTER UNIVERSITY PARK PA 16802-4601 814-863-0395

1881011435 STRATTON CORINNE 119 BELMONT STREET WORCESTER MA 01605-2903 508-334-1886

1619966710 STRAUSS MARK 1000 WEST MORENO ST PENSACOLA FL 32501-2316 888-851-7590

1982038048 STRAYER TED 2440 WHITNEY AVE HAMDEN CT 06518-2601 203-281-5468

1669432258 STREETER GORDON 55 LOCK STREET NEW HAVEN CT 06511-3603 203-432-0076

1851654925 STRETZ HANNS 20 YORK STREET YNHH DEPT NEUROLOGY NEW HAVEN CT 06510-3220 203-688-4242

1891223103 STRIEBE KIERSTEN 4 CORPORATE DRIVE SUITE 386 SHELTON CT 06484-6240 203-538-5682

1619966652 STROBER BRUCE 21 SOUTH ROAD FARMINGTON CT 06032-6231 860-679-4600

1124019815 STRONG VIVIAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1316175565 STRUCKMAN TODD 915 E FIRST ST DULUTH MN 55805-2107 800-633-2243

1457441321 STUCKEY ASHLEY 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1366684060 STULL MICHAEL 3636 HIGH ST PORTSMOUTH VA 23707-3236 419-226-4343

1841550738 STUMP MARIAH 148 WEST RIVER STREET SUITE 1G PROVIDENCE RI 02904-2615 401-793-7817

1649200676 STUPIK STEPHEN 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1356459093 SU EDWIN 535 EAST 70TH STREET NEW YORK NY 10021-4823 646-707-8471

1538235163 SUBRAMANIAN SHIELA 173 EAST AVE NEW CANAAN CT 06840-5614 203-972-4236

1427286715 SUCHENSKI MAUREEN 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-921-7362

1962474684 SUCSY ROBERT 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1114997137 SUGIN STEPHANIE 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1083102982 SUH CHRISTINA 333 CEDAR STREET SUITE 329 FMB NEW HAVEN CT 06520-8063 203-785-6927

1861483414 SUHOCKI DAVID ADVANCED DERMATOLOGY CENTER 464 WOLCOTT ROAD WOLCOTT CT 06716-2626 203-879-6171

1164516670 SULLIVAN CHRISTINE 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 516-458-7837

1649286774 SULLIVAN FRANCIS 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1578584165 SULLIVAN HEATHER 108 COUNTY ROAD EASTFORD CT 06242-0108 860-315-5740

1801130901 SULLIVAN JENNIFER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1114037504 SUNER SELIM 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1124262803 SUPPIAH ARAVINTHAN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1437193604 SUREDDI PRASAD 10 MAIN STREET SOUTH SOUTHBURY CT 06488-2260 203-264-6334

1700892833 SUTTON ELIZABETH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-6125

1083886154 SWANSON SUSAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1659337038 SWEENEY CHRISTOPHER 450 BROOKLINE AVE DANA-FARBER CANCER INSTITUTE BOSTON MA 02215-5405 617-632-3466

1669697454 SWEENEY LYNN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1013958057 SWORDS ROBERT 140 GLASTONBURY BLVD GLASTONBURY CT 06033-4402 860-869-1778

1528344926 SYDNEY STEPHANIE 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

HUSKY Health Connecticut Page 55 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 56: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1639127749 SYLVIA LISA 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-447-2752

1306163829 SYRKIN GRIGORY 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1366409450 SZAKACS GAIL 3 HOLLYHOCK RD WILTON CT 06897-4443 203-834-2813

1770965345 SZCZUR RACHEL 759 CHESTNUT STREET SPRINGFIELD MA 01199-1619 413-794-3233

1417020686 SZILAGYI NATHALIE 230 SOUTH FRONTAGE ROAD YALE MEDICINE CHILD STUDY CTR NEW HAVEN CT 06519-1124 203-737-7129

1114347051 SZUCHMACHER MARIANA 8714 5TH AVE BROOKLYN NY 11209-5204 516-663-2818

1083190243 SZUMSKA SYLWIA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-331-0660

1336123983 TABAR VIVIANE 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1174571194 TAFT JAMES 593 EDDY STREET APC 6 PROVIDENCE RI 02903-4923 401-793-9167

1740335629 TAGLIARINI JOSEPH 389 ORANGE STREET NEW HAVEN CT 06511-6442 203-624-5515

1659839751 TALARICO ALEXANDER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1467816033 TALIADOROS PARASREVI 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1154340792 TALLMAN MARTIN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3742

1306235940 TAMARIT ALEXANDER 11750 BIRD ROAD MIAMI FL 33176-3530 888-851-7590

1235301318 TAN TIMOTHY 259 FIRST STREET MINEOLA NY 11501-3957 516-663-8510

1629041728 TANKSLEY RADFORD 111 SALEM TURNPIKE SUITE 7 NORWICH CT 06360-7403 860-859-2262

1730589292 TARASOVIC LINDSAY 950 CAMPBELL AVE BUILDING 1 GROUND FLOOR G101 WEST HAVEN CT 06516-2770 203-932-5711

1184935322 TASSINARI JULIA 11 FRIENDSHIP STREET NEWPORT RI 02840-2299 401-845-1652

1609355593 TAUBERT CHRISTINA 450 BROOKLINE AVENUE BOSTON MA 02215-5410 617-632-2166

1033314406 TAUSEVICH DAVID 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1750792321 TAYLOR GRAHAM 950 CAMPBELL AVE WEST HAVEN CT 06511-2770 434-962-1906

1124099890 TAYLOR JETER 3 MEDICAL PARK PALMETTO HEALTH RICHLAND COLUMBIA SC 29203-6863 614-267-9416

1003203936 TAYLOR JOSEPH 300 GEORGE STREET SUITE 901, ROOM 25 NEW HAVEN CT 06511-6662 203-785-2095

1669483939 TAYLOR STEPHANIE 300 SUMMIT ST TRINITY COLLEGE HEALTH CENTER HARTFORD CT 06106-3100 860-297-2018

1649452806 TAZELAAR JAMES 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1811222300 TEAPE DANIELLA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-8984

1558426478 TEEKING DENNIS 184 MT. PLEASANT RD NEWTOWN CT 06470-1408 203-426-0500

1932575370 TEO MIN YUEN 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-6007 646-227-3764

1902829542 TEPPER JEFFREY 15 NEW BRITAIN AVENUE UNIONVILLE CT 06085-1277 860-673-2455

1386958346 TERKELL SHANNON 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-444-4171

1770577298 TERLATO JOSEPH 1351 S COUNTY STE 115 EAST GREENWICH RI 02181-5079 401-421-4000

1952535494 TERMEER JENNIFER 8260 ATLEE ROAD MECHANICSVILLE VA 23116-1844 416-226-4343

1154450450 TESLUK CATHERINE 240 BRADLEY ST NEW HAVEN CT 06510-1108 203-562-4942

1154388361 TESORO MICHAEL 152 EAST STREET SHARON CT 06069-2415 860-364-5615

1386750735 TESSLER AARON 652 BOSTON POST RD GUILFORD CT 06437-2770 203-453-4028

1578553830 TETTEY PEPPINO 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1437361870 THAKKAR VATSAL 1720 POST RD E. SUITE 223 WESTPORT CT 06880-5643 203-220-6390

1407939713 THAKRAL VIKAS 3636 HIGH ST PORTSMOUTH VA 23707-3236 419-226-4343

1568666352 THAKRE TUSHAR 1250 E MARSHALL ST RICHMOND VA 23298-5051 800-645-3055

1598225609 THAPA RESHNA 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-856-0321

1679624712 THARPE JACOB 119 BELMONT STREET WORCESTER MA 01605-2903 508-793-6348

1659324515 THIBAULT PA MICHAEL 761 MAIN AVE SUITE 102 NORWALK CT 06851-3162 860-282-4128

1346883592 THIEL TAYLOR 1000 WHITE HORSE ROAD STE 802 VOORHEES NJ 08043-4414 856-324-3242

1306122494 THIESEN JENNIFER 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

HUSKY Health Connecticut Page 56 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 57: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1508304619 THOLE AMANDA 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1417243098 THOMAS ANDREW 1 TAMPA GENERAL CIRCLE TAMPA FL 33606-3571 888-851-7590

1285692947 THOMAS ANTHONY 593 EDDY STREET APC 138 PROVIDENCE RI 02903-4923 401-444-5435

1770816175 THOMAS EMMA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1043440100 THOMETZ DONALD 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1558529255 THOMPSON KATHRYN 4 CORPORATE DRIVE SUITE 386 SHELTON CT 06484-6211 203-538-5682

1518911387 THOMPSON LAURA 52 BEACH RD # 104 FAIRFIELD CT 06824-3456 203-254-2000

1043233240 THOMSEN JEFFREY 55 TOWN LINE ROAD SUITE 202 WETHERSFIELD CT 06109-4352 860-529-5280

1689609497 THORNTON KATHERINE 450 BROOKLINE AVENUE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-5917

1982694972 THORNTON LAURINE 211 PARK STREET ATTLEBORO MA 02703-3143 508-236-8139

1376930214 THORSON ANDREW 600 NORTHERN BLVD. ALBANY NY 12204-1004 800-645-3055

1174676837 TIBERI THOMAS 3015 MAIN STREET BRIDGEPORT CT 06606-4215 203-365-0015

1023394657 TIEMO AEMI 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1376796094 TIMMER PHRYNEE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1043531973 TIOLECO NINA 710 W 168TH ST 12TH FLOOR NEW YORK NY 10032-3726 212-305-9758

1275590150 TOBACK GREGORY 190 HEMPSTEAD STREET NEW LONDON CT 06320-6248 860-443-2428

1881773976 TOBKES JONATHAN 115 EAST 61ST STREET SUITE 7F NEW YORK NY 10065-8185 212-861-0763

1275515371 TOKUNO HAJIME VA CONNECTICUT HEALTHCARE SERV 950 CAMPBELL AVE WEST HAVEN CT 06516-2770 203-937-4724

1720421472 TOLLEY JESSICA 11705 MERCY BLVD SAVANNAH GA 31419-1711 800-645-3055

1841556974 TOMECSEK KEVIN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1841349883 TONDREAU JOSEPH 363 HIGHLAND AVENUE FALL RIVER MA 02720-3703 508-973-3584

1750853115 TORCHIA NICOLE 759 CHESTNUT ST SPRINGFIELD MA 01107-1619 413-794-6297

1912393935 TORETTA CARA 20 YORK STREET CHILD & ADOLESCENT PSYCHIATRY NEW HAVEN CT 06510-3220 203-737-7129

1508122748 TORTOLANI BESS 725 NORTH STREET PITTSFIELD MA 01201-4019 413-447-2726

1619205341 TOWLE ANTOINETTE 80 PROSPECT ST WATERBURY CT 06708-1327 203-506-8909

1114288610 TOZER JORDAN 1250 EAST MARSHALL STREET RICHMOND VA 23298-5051 800-645-3055

1780769919 TRACY TODD 40 COMMERCE PARK SUITE 1 MILFORD CT 06460-3506 203-878-3531

1780659292 TRACY III DMD DANIEL 100 FANNING AVENUE NORWICH CT 06360-2943 860-892-4996

1659734127 TRAFTON SARAH DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVENUE BOSTON MA 02215-5418 617-632-5917

1134433725 TRAN CAO 2 DUDLEY STREET PROVIDENCE RI 02905-3236 401-453-4500

1750769840 TRAN KHOI ONE MEDICAL CENTER BLVD COOKEVILLE TN 38501-0001 931-783-5582

1447396973 TREADO ROBERT 670 EAST ROAD BRISTOL CT 06010-6845 860-589-0874

1811287451 TREHAN SAMIR 535 E 70TH ST NEW YORK NY 10021-4823 212-744-7598

1750708103 TRIVEDI ANJUA 1 CAPITAL WAY PENNINGTON NJ 80534-2520 215-442-5084

1376638254 TRODDYN MICHAEL 281 LINCOLN STREET WORCESTER MA 01605-2138 508-793-6348

1396198420 TROSHIN VLADISLAV 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1720098247 TROWBRIDGE RANDY 22 EAGLE ROAD DANBURY CT 06810-4129 203-778-8326

1073684361 TRUPIANO PHILIP 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-273-0641

1851353551 TSANG BRIAN 200 MILL ROAD FAIRHAVEN MA 02719-5208 508-973-3584

1356395966 TUBBS ROBERT 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1275648552 TUCKER EDWARD 67 NORTH MAIN ST ESSEX CT 06426-0132 860-767-1411

1558655134 TUCKER VERONICA 80 HIGHLAND STREET LACONIA NH 03246-3235 603-524-3211

1679763882 TULL ERICA 6245N. INKSTER RD GARDEN CITY MI 48135-4001 918-203-0114

HUSKY Health Connecticut Page 57 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 58: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1851487649 TULSKY JAMES 450 BROOKLINE AVE DANA FARBER CANCER INSTITUTE BOSTON MA 02215-5418 617-632-6464

1861584575 TUMENIUK ALEXANDER 345 BOSTON POST ROAD MILFORD CT 06460-2528 203-876-2696

1972799799 TUNG DAVID 3180 MAIN ST, SUITE 303 CORE PHYSICAL THERAPY BRIDGEPORT CT 06606-4237 203-373-1593

1487759478 TUNICK HOWARD 199 MAIN STREET DEEP RIVER CT 06417-2021 860-526-9519

1376668178 TUREK THOMAS 1389 WEST MAIN ST SUITE 208 WATERBURY CT 06708-3115 203-757-1287

1770975310 TURENNE ELIZABETH 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1356312854 TUTTLE ROBERT 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1154383842 TYER JAMES 60 HOSPITAL ROAD LEOMINSTER MA 01453-2205 508-793-6348

1932549490 TYSON REBECCA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1841330107 ULLOA RAUL 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1083931067 UNDURRAGA PERL VICENTE 1055 NORTH CURTIS ROAD BOISE ID 83706-1309 800-645-3055

1306200159 UWOGHIREN KELLY 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1518098375 UY GEORGE 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1619278132 UYEKLIONG MARC 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 415-547-5151

1508932294 VALENTINE JOHANNAH 111 SALEM TURNPIKE SUITE 7 NORWICH CT 06360-7403 860-859-2262

1245437714 VALERAS ANDREW 250 PLEASANT STREET CONCORD NH 03301-7539 603-228-7200

1932497328 VALLEE LEANNE 83 SOUTH STREET WARE MA 01082-1660 413-967-2040

1700966306 VALLUZZO THOMAS WHITE STREET SMILES 289 WHITE DANBURY CT 06810-5628 203-743-4670

1336110063 VAN DEN BRINK MARCEL 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1699963884 VAN METER CHARLES 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1861666539 VANASSE REBECCA 11 WELLS ST WESTERLY RI 02891-2998 401-273-0641

1982760823 VANCURAN KEITH 173 MIDDLE STREET LANCASTER NH 03584-3508 508-482-9600

1114213410 VARAMO VINCENT 455 TOLL GATE ROAD WARWICK RI 02886-9252 401-273-0641

1689180952 VARGAS ARMAND 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1184024374 VARGHESE ROGER 736 IRVING AVENUE SYRACUSE NY 13210-1690 800-645-3055

1932126398 VARZOS KATINA 189 ORANGE STREET NEW HAVEN CT 06510-3604 203-937-2309

1558425678 VASILE JULIE 1290 SUMMER ST SUITE 2200 STAMFORD CT 06905-5339 203-965-0656

1225589625 VAUGHAN ADAM 759 CHESTNUT STREET S4628 SPRINGFIELD MA 01107-1619 413-794-5550

1336193531 VAUGHN LAURA 400 PALMETTO HEALTH PARKWAY COLUMBIA SC 29212-1760 888-851-7590

1255449716 VAZQUEZ BLANCA 223 EAST 34TH ST. 14 WALL STREET, 9TH FLOOR NEW YORK NY 10016-4852 646-207-5287

1346336617 VEACH STEPHEN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1124274204 VEGA ROXANA 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1346725421 VELASCO NANCY 999 SUMMER STREET SUITE 304 STAMFORD CT 06905-5513 203-325-5700

1780870659 VELASQUEZ ADRIAN 11 FRIENDSHIP STREET NEWPORT RI 02840-2209 401-846-6400

1932496098 VERMA POOJA 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-273-0641

1861495681 VERSEA LINDA 24 STEVENS ST WHITTINGHAM CANCER CENTER NORWALK CT 06850-3852 203-852-2000

1760905723 VINIK KEVIN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-8152

1922411628 VIRADIA RAVI 195 EASTERN BOULEVARD STE. 200 GLASTONBURY CT 06033-4353 860-781-6294

1417147406 VISCHIO JOHN 195 EASTERN BLVD SUITE 201 GLASTONBURY CT 06033-4353 860-246-4260

1457853301 VONA JARED 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1023102068 VONBLEICKEN JACLYN 157 UNION STREET MARLBOROUGH MA 01752-1228 508-793-6348

1518955517 VOSBURGH EVAN 800 HOWARD AVE YALE UNIVERSITY NEW HAVEN CT 06519-0309 203-785-4216

1013998244 VOSS KERSTIN 29 LEWIS STREET GREAT BARRINGTON MA 01230-1713 413-881-5427

1639245269 VOYTOVICH JULIA 173 EAST AVENUE NEW CANAAN PERSONAL MEDICINE NEW CANAAN CT 06840-5614 203-972-4236

HUSKY Health Connecticut Page 58 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 59: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1477968188 WADHWA ANANT 20 YORK STREET YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1740226984 WAITE MARYBETH 1011 VETERANS MEMORIAL PARKWAY EAST PROVIDENCE RI 02915-5061 401-432-1000

1285133231 WALKER KATIE 119 BELMONT STREET WORCESTER MA 01605-2903 508-334-6173

1770683013 WALKER W. SCOTT 1 RANDALL SQUARE PROVIDENCE RI 02904-2709 401-273-0641

1548283336 WALLACE JENNIFER 101 PAGE STREET NEW BEDFORD MA 02740-3464 508-482-9600

1609838689 WALLINGTON DALE 1216 FARMINGTON AVE SUITE 303 WEST HARTFORD CT 06107-2673 860-313-5380

1558357400 WALLS FURMAN 800 WASHINGTON STREET BOSTON MA 02111-1552 800-883-9986

1437475928 WALLS KRISTEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-334-8152

1699869644 WALSH KATHLEEN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1407017742 WANDEL ERIKA 1201 WEST MAIN STREET SUITE 100 WATERBURY CT 06708-3105 203-573-4803

1114313707 WANG CHARLOTTE 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-442-6534

1225258338 WANG JEFF 100 TECHNOLOGY DRIVE SUITE 210 TRUMBULL CT 06611-6303 203-880-5416

1649217803 WANG LI JUAN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-5152

1962449512 WANG TIMOTHY 136 WEST MAIN STREET FIRST FLOOR NEW BRITAIN CT 06051-1315 860-826-4763

1457579963 WANGLER VALORY 1901 RED ROCK DRIVE GALLUP NM 87301-1901 800-645-3055

1386626133 WARMAN MARC 409 MOUNTAIN LAUREL ROAD FAIRFIELD CT 06824-2424 203-216-0178

1285898890 WARREN OTIS 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1487792305 WASKO KIM 140 WILLOW STREET SUITE 2 SUITE 2 WINSTED CT 06098-2092 860-379-4809

1265692784 WATSON JAMES 363 HIGHLAND AVE FALL RIVER MA 02720-3703 508-973-3584

1538405923 WATSON MICHELLE 30 SHELBURNE RD STAMFORD CT 06902-3628 203-276-7058

1962763656 WATSON SARA 1 RIVER STREET THUNDERMIST HEALTH CENTER WAKEFIELD RI 02879-3214 401-767-4100

1588142939 WAY VICTORIA 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1831638782 WAYSHVILLE RICHARD 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1407144314 WEAGRAFF NATHAN 601 E. ROLLINS STREET ORLANDO FL 32803-1248 800-645-3055

1902946890 WEAVER JACQUELINE 2215 BURDETT AVE TROY NY 12180-2466 518-271-3450

1285091850 WEBBER KARENA 100 HOSPITAL DRIVE BENNINGTON VT 05201-5004 802-447-4509

1386781722 WEBBER PATRICIA 181 PARK AVE SUITE 16 WEST SPRINGFIELD MA 01089-3365 413-256-0100

1528366739 WEBSTER JENNIFER 55 FRUIT ST BOSTON MA 02114-2696 617-726-2330

1689676405 WEEKS LONG JANIE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1467809319 WEI ELIZABETH 20 YORK STREET YNHH PEDIATRICS CRITICAL CARE NEW HAVEN CT 06510-3220 203-785-4651

1962057489 WEICKERT ELEANOR 33 KENDALL STREET WORCESTER MA 01605-2726 508-334-8152

1376561282 WEIGNER MARILYN 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5891

1649343807 WEINER GAIL 8 W END AVE OLD GREENWICH CT 06870-1642 203-637-3212

1558703892 WEISKOPF ELIZABETH DANA FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5418 617-632-2044

1619052131 WEISS DAVID 1211 WHITE PLAINS RD BRONX NY 10472-4900 718-628-6610

1649484445 WEISS ERICA 303 WHITNEY AVE NEW HAVEN CT 06511-3765 203-376-1165

1871500793 WEISS JOSEPH 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-444-6779

1649307778 WEISS WUERTH JANA 175 COPSE RD MADISON CT 06443-2323 203-245-2778

1871511725 WELBY MELISSA 99 CHERRY ST UNIT D MILFORD CT 06460-3455 203-906-6294

1174741656 WELCH JENNIFER 593 EDDY STREET HASBRO LOW LEVEL PROVIDENCE RI 02903-4923 401-444-4471

1508887290 WELLNER MURRAY 10 DALE STREET WEST HARTFORD CT 06107-1815 860-521-9451

1750319273 WELLS JESSE 1800 WEST CHARLESTON BLVD LAS VEGAS NV 89102-2329 385-695-1656

1588720247 WELSH BARBARA 30 TRUMAN WAY ROCKY HILL CT 06067-2070 860-257-1020

1053393496 WEN PATRICK DANA-FARBER CANCER INSTITUTE 450 BROOKLINE AVE BOSTON MA 02215-5450 617-632-2166

HUSKY Health Connecticut Page 59 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 60: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1851461214 WENICK GARY 2050 ROUTE 22 BREWSTER NY 10509-5948 914-242-5621

1225265028 WERELY JENNIFER 500 WEST PUTNAM AVE SUITE 400 GREENWICH CT 06830-6096 203-900-4226

1295783819 WESPISER ROBERT 620 LAUREL STREET LAUREL LAKE NURSING HOME LEE MA 01238-9316 413-243-0122

1992703904 WESTBROOK ANNICK 250 PLEASANT STREET CONCORD NH 03301-7539 603-228-7200

1346431657 WESTPHAL ALEXANDER 34 PARK STREET NEW HAVEN CT 06519-1109 860-381-9880

1780681064 WHALEN JAMES 21 SOUTH ROAD UCONN MEDICAL GROUP FARMINGTON CT 06032-6231 860-679-4600

1376637322 WHALEY PAUL 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1265459143 WHARTON GARY 235 PLAIN ST SUITE#401 PROVIDENCE RI 02905-3240 401-273-0641

1104278472 WHEELER AARON 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1356442404 WHEELER LAUREN 759 CHESTNUT STREET SPRINGFIELD MA 01199-1619 413-794-4022

1386706372 WHIKEHART DOUGLAS 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1598703332 WHITALL RUTH 100 CENTURY DRIVE WORCESTER MA 01606-1244 508-762-5400

1437485182 WHITE CHRISTOPHER 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-637-9034

1407017684 WHITE JOSHUA 246 PLEASANT STREET SUITE 104 CONCORD NH 03301-2548 603-230-1939

1124087903 WICHMANN EUGEN 55 WHITING ST. SUITE 2C PLAINVILLE CT 06062-2262 860-747-5529

1083919369 WICKERT KERRY 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1730496415 WICKRAMASINGHE HETTI 1850 TOWN CENTER PKWY RESTON VA 20190-3219 888-851-7590

1215092440 WICKS CHARLES 246 PLEASANT STREET SUITE 103 CONCORD NH 03301-2548 603-224-6070

1932596087 WIDDICOMBE ABBOTT 464 CONGRESS AVE YNHH DEPT EMERGENCY MEDICINE NEW HAVEN CT 06519-1361 203-785-5174

1376587766 WIEMER DAVID 680 BRIDGEPORT AVENUE SUITE 3 SHELTON CT 06484-6811 203-924-8922

1912928524 WIENER MICHELE 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400

1982855581 WIEPERT ERIC 10000 W COLONIAL DR OCOEE FL 34761-3499 800-645-3055

1558417576 WILCOX GREGG 47 BINGHAM ROAD CANTERBURY CT 06331-1924 860-208-8401

1346761418 WILCOX KELSEY 23 WAUREGAN RD BROOKLYN CT 06234-1924 860-774-0876

1942646161 WILEY MELORA 1 LONG WHARF DRIVE YNHH PEDIATRIC DEVELOPMENT NEW HAVEN CT 06511-5991 203-785-7521

1588026702 WILKINS CURTIS 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6556

1821577594 WILLARD MATTHEW 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1649642166 WILLIAMS BARRINGTON 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1073589396 WILLIAMS CARLA 159 WEST PUTNAM AVENUE GREENWICH CT 06830-5329 203-869-7080

1831222629 WILLIAMS ELLEN 287 WEST ST STATE OF CT DVA ROCKY HILL CT 06067-3501 860-616-3778

1316953458 WILLIAMS KENNETH 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1689184368 WILLIAMS MALYSSA 3300 MAIN STREET 3RD FL, SUITE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1235159583 WILLIAMS JR JOSEPH 72 NORTH ST, SUITE 103 DANBURY CT 06810-5653 203-748-1200

1295822609 WILLNER EMILY 111 MICHIGAN AVENUE NW WASHINGTON DC 20010-2970 301-572-3591

1811159452 WILSON JASON 1 TAMPA GENERAL CIRCLE TAMPA FL 33606-3571 888-851-7590

1184984072 WILSON TANEISHA 593 EDDY STREET UNIVERSITY EMERGENCY MEDICINE PROVIDENCE RI 02903-4923 401-854-2504

1407996986 WINACOO JEFFREY 55 LAKE AVENUE NORTH WORCESTER MA 01655-0001 508-793-6348

1255665816 WINANS AUDREY 800 WASHINGTON STREET BOSTON MA 02111-1552 617-636-8137

1033270988 WINIARSKI STEVEN 21 E 4TH STREET NEW YORK NY 10003-7012 302-313-1584

1922186840 WINTERS THOMAS 1385 HANCOCK ST QUINCY MA 02169-5103 617-770-7882

1902874449 WISOR DOUGLAS 67 SANDPIT RD STE. 308 DANBURY CT 06810-4032 410-329-1071

1881811008 WITHERBY SABRINA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-5435

1932553898 WITKOVIC MATTHEW 400 CAPITAL BLVD ROCKY HILL CT 06067-3576 860-833-3513

HUSKY Health Connecticut Page 60 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 61: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1346355989 WITTENBERG ALISON 60 WASHINGTON AVENUE SUITE 102 HAMDEN CT 06518-3203 203-407-6444

1083877930 WODOWSKI STEPHANIE 3636 HIGH STREET PORTSMOUTH VA 23707-3236 804-627-5573

1801056544 WOELZLEIN DEVIN 408 HAZEN STREET PAW PAW MI 49079-1019 800-633-2243

1447413505 WOHLRAB KYLE 101 DUDLEY STREET 5TH FLOOR PROVIDENCE RI 02905-2401 401-273-0641

1851474068 WOJCIK JOHN 3300 MAIN STREET 3RD FL, SUITE C&D SPRINGFIELD MA 01107-1112 413-794-5600

1588929046 WOLFF MARISA 18 CONGRESS ST STE 2 SARATOGA SPRINGS NY 12866-4172 518-350-4694

1710903521 WOLFSON DANIEL 528 WASHINGTON HIGHWAY MORRISVILLE VT 05661-8973 588-482-9600

1285805812 WOLFSON WENDY 21 LOCUST AVE NEW CANAAN CT 06840-5327 917-499-8250

1437143237 WOLK LARRY 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1316338668 WOLLER RICHARD 3300 MAIN STREET 3RD FL, SUITE A&B SPRINGFIELD MA 01107-1112 413-794-7364

1013175439 WON ELIZABETH 1275 YORK AVE 633 3RD AVE 3RD FL NEW YORK NY 10065-3200 646-227-3764

1720304603 WONG HENRY 1500 NORTH 28TH ST. RICHMOND VA 23223-5332 804-627-5573

1366460339 WOO ALBERT 593 EDDY STREET PROVIDENCE RI 02903-4923 401-606-1248

1548374960 WOO DAVID 933 MAMARONECK AVENUE SUITE 202 MAMARONECK NY 10543-1661 917-513-8537

1255371159 WOOD BRET 1101 NOTT STREET SCHENECTADY NY 12308-2425 385-695-1941

1811436744 WOODARD DASHARDRA 2215 BURDETT AVENUE TROY NY 12180-2466 800-645-3055

1033323258 WOODBURY ROBERT 1200 EAST PUTNAM AVENUE RIVERSIDE CT 06878-1430 203-637-8114

1780680728 WOODFORD SCOTT 817 BOSTON POST ROAD MADISON CT 06443-3155 203-245-4266

1285875062 WOODRUFF MARIANNE 455 TOLL GATE ROAD WARWICK RI 02886-2759 401-273-0641

1437225695 WOODWARD JANET WILLOWS PEDIATRICS 1563 POST ROAD EAST WESTPORT CT 06880-5602 203-319-3939

1568467132 WOOL ROBERT 65 SPRINGFIELD RD WESTFIELD MA 01085-4514 413-562-8306

1215582796 WOS JUSTYNA 759 CHESTNUT STREET SPRINGFIELD MA 01107-1619 413-794-3233

1992347397 WRAIGHT SHEENA 2701 TAMARACK AVENUE SOUTH WINDSOR A CT 06074-5562 860-375-5141

1922084078 WRIGHT AMY 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1952546012 WRIGHT GENEVIEVE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-793-6348

1194012138 WRIGHT SHAWNA 6245 INKSTER ROAD GARDEN CITY MI 74135-4001 918-203-0114

1003236852 WU ERIC 3790 E. WOODMEN RD. COLORADO SPRINGS CO 80920-4139 800-645-3055

1386658219 WUDARSKY MARIANNE 915 RIVER ROAD MIDDLETOWN CT 06457-4402 203-415-5882

1124199708 WYNN PE 800 CROSS RIVER RD KATONAH NY 10536-3549 914-763-8151

1295969715 XELLER KRISTEN 697 POMFRET ST POMFRET CENTER CT 06259-1139 860-315-5400

1447209895 XIONG YUTING 970 SUMMER STREET 2ND FLOOR STAMFORD CT 06905-5518 203-324-2128

1992841167 XU WEI 100 WELLS STREET SUITE 1B HARTFORD CT 06103-2920 860-249-4466

1174955744 YABIDI VICTOR 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1013959774 YAKOBI SHVILI RAMY 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1609335850 YAKUZE ERIC 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

1063511210 YALE ABRAHAM 1881 POST RD FAIRFIELD CT 06824-5721 203-255-1036

1194111617 YANCOPOULOS KAREN 31 RIVER RD COS COB CT 06807-2152 203-863-2003

1538541560 YANG KUN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-4489

1356594410 YANIK THOMAS 2 CONCORDE WAY, BLDG 1 WINDSOR LOCKS CT 06096-1577 860-623-1116

1265775084 YARNELL STEPHANIE 300 COLLEGE STREET YUSM DEPT OF PSYCHIATRY NEW HAVEN CT 06511-0805 203-785-2094

1881920205 YARZEBSKI KATE 119 BELMONT STREET UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01605-2903 508-334-6477

1821044801 YATCHMINK YVETTE 593 EDDY STREE PROVIDENCE RI 02903-4923 401-444-5440

1447242102 YEE ARTHUR 28 COACHLAMP LANE GREENWICH CT 06830-4003 203-622-2939

HUSKY Health Connecticut Page 61 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 62: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1952461550 YEGER-MCKEEVER MEIRA 1645 CHAMPLIN AVENUE UTICA NY 13502-4380 315-625-5169

1184709941 YEH EDWARD 2720 SUNSET BLVD WEST COLUMBIA SC 29169-4810 803-791-2275

1043576747 YEH JUDY 20 YORK ST. YNHH TOMPKINS 226 NEW HAVEN CT 06510-3220 203-688-9503

1457373862 YEH RONALD 1600 S ANDREWS AVE FORT LAUDERDALE FL 33316-2510 800-633-2243

1467445072 YERDON MCLEOD ANGELA 250 PLEASANT STREET CONCORD NH 03301-7539 603-228-7200

1831577303 YERMAKOV OLEG 3300 MAIN STREET 3RD FLOOR, SUITE C&D SPRINGFIELD MA 01199-1619 413-794-7033

1780068437 YERRAGORLA PRIYANKA 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-4000

1952657629 YIN VIVIAN 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3742

1811954746 YOUNG AMY 2876 MAIN STREET STRATFORD CT 06614-4984 203-696-6125

1467852095 YOUNG CHRISTINA 134 PARK STREET NEW HAVEN CT 06511-5409 203-865-6143

1356660286 YOUNG COLIN 20 YORK STREET DEPT OF RADIOLOGY NEW HAVEN CT 06510-3220 203-688-9503

1679057319 YOUNG JAKE 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1427144625 YOUNG JAMES MSKCC 1275 YORK AVENUE NEW YORK NY 10065-9321 646-227-3764

1639488745 YOUNG JENNIFER 84 HOSPITAL AVE DANBURY CT 06810-6047 203-769-1312

1538226626 YOUNG WENDY 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1750325494 YU DANIEL 727 NORTH BEERS STREET HOLMDEL NJ 07733-1514 623-241-8324

1750644662 YU ESTHER 593 EDDY STREET PROVIDENCE RI 02903-4923 401-444-3600

1871791665 YU HELENA 1275 YORK AVE MEMORIAL SOLID TUMOR GROUP NEW YORK NY 10065-6007 646-227-3742

1831522184 YUN HO 2 MEDICAL CENTER DRIVE SUITE 503 SPRINGFIELD MA 01107-1270 413-794-5600

1710908306 YUN RICHARD 400 PROSPECT STREET NEW HAVEN CT 06511-2181 203-909-6370

1770556185 ZAFAR UZMA 2075 E FLAMINGO RD LAS VEGAS NV 89119-7442 702-473-8900

1043203995 ZAIDMAN GERALD 95 GRASSLAND RD WESTCHESTER MEDICAL CENTER VALHALLA NY 10595-1552 914-493-1599

1457515603 ZAINAH HADEEL 455 TOLL GATE RD WARWICK RI 02886-2759 401-737-7000

1215918404 ZAITER PEDRO 1500 N 28TH ST RICHMOND VA 23223-5332 419-226-4343

1558599464 ZALUSKI KATE 101 DUDLEY STREET PROVIDENCE RI 02905-2401 401-273-0641

1831299882 ZARKOWSKY FRANK 21 ADAMS RD RIDGEFIELD CT 06877-5929 203-438-2309

1396858288 ZATMAN MARINA 122 SOUTH POMPERAUG AVE UNIT 2 WOODBURY CT 06798-3708 203-314-1986

1588175442 ZAW NINI 800 CROSS RIVER ROAD KATONAH NY 10536-3549 914-763-8151

1023664109 ZAWALICH DANIEL 8 BURNHAM STREET TURNERS FALLS MA 01376-1816 413-774-3751

1528432317 ZAWROTNIAK PETER 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1952490732 ZEBEDE BLANK MARCELA 164 SUMMIT AVENUE BLDG 2B PROVIDENCE RI 02906-2853 401-793-4300

1447385976 ZEBERT STEVEN 169 MARTIN AVE EPHRATA PA 17522-1724 800-645-3055

1972527646 ZEITLIN KEITH 850 N. MAIN STREET EXT. BUILDING 2, SUITE 3C WALLINGFORD CT 06492-2469 203-284-1119

1528314580 ZELIKSON DMITRIY 111 CENTRAL AVE. NEWARK NJ 07102-1909 800-377-8721

1962455311 ZELMAN ARTHUR 101 ROCKLAND AVE MAMARONECK NY 10543-3307 914-698-3210

1063458859 ZELMAN JARED 11 INTERLAKEN ROAD LAKEVILLE CT 06039-2096 860-435-3226

1306057963 ZERVOUDAKIS ALICE 500 WESTCHESTER AVE MSK HARRRISON WEST HARRISON NY 10604-6007 646-227-3742

1598080962 ZEUREN REBECCA 1275 YORK AVE NEW YORK NY 10065-6007 646-227-3764

1225477896 ZHU SHENJUN 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1477589174 ZIANIO LELA 400 CAPITAL BLVD ROCKY HILL CT 19713-3101 860-652-5481

1356379390 ZIENOWICZ RICHARD 164 SUMMIT AVENUE PROVIDENCE RI 02906-2853 401-793-2500

1730269317 ZILAHY PETER 35 CANDEE HILL RD WATERTOWN CT 06795-3101 860-274-9641

1538489315 ZIMMERMAN PATRICK 315 S MANNING BLVD ALBANY NY 12208-1707 800-645-3055

1003275892 ZINKUS DANIEL 55 LAKE AVENUE NORTH UMASS MEMORIAL MEDICAL GROUP WORCESTER MA 01655-0002 774-443-7552

HUSKY Health Connecticut Page 62 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)

Page 63: OPR Provider Listing - HUSKY Health Program1023216280 AGUIRRE ESTHER 75 SEMINARY HILL RD. CARMEL NY 10512-1921 845-225-3400 CARMEL NY 10512-1921 845-225-3400 1619482510 AGYAPONG FAUSTINA

NPI Last Name First Name Service Address Line 1 Service Address Line 2 City State Zip Code Phone Number

1386115970 ZINN KATIE 1817 BLACK ROCK TURNPIKE SUITE 205 FAIRFIELD CT 06825-3504 717-825-4545

1992773154 ZMURKO MATTHEW 160 ALLEN STREET RUTLAND VT 05701-9977 802-747-1633

1235180852 ZONFRILLO MARK 593 EDDY STREET PROVIDENCE RI 02903-4923 401-854-2504

1821528506 ZUCKER SUSAN 55 LAKE AVENUE NORTH WORCESTER MA 01655-0002 508-334-6173

1720457104 ZULLO ERIN 400 CAPITAL BLVD 3RD FLOOR ROCKY HILL CT 06067-3576 860-221-0791

1225059116 ZWAS FELICE 15 VALLEY DRIVE 3RD FLOOR GREENWICH CT 06831-5205 203-489-6900

HUSKY Health Connecticut Page 63 of 63 6/11/2020 7:00:06 AM

OPR Provider Listing (Ordering/Prescribing/Referring)