Andrew Medvedovsky
Debarred entityUnited States. Named in 3 sanctions listings.
Summary
License number: 101248161
Sanctions and listings3
- Effective
- 4 Aug 2020
Official designation
Department of Human ServicesUS Pennsylvania Medicheck listUnited StatesPrecluded
- Effective
- 4 Aug 2020
Official designation
New Jersey Office of the State ComptrollerUS New Jersey Ineligible Medicaid ProvidersUnited States
DISQUALIFICATION
- Effective
- 4 Aug 2020
Official designation
Pennsylvania Department of Human servicesUS Delaware Medicaid Sanctioned ProvidersUnited States
Terminate Provider Agreement-Terminated- Reporting Only Managed Care
Identifiers2
| Identifier | Number |
|---|---|
| ID number | MD468530 |
| NPI number | 1649431594 |
Other names1
Also known as1
Addresses3
11 AUTUMN DRIVE, MOORESTOWN, NJ 08057
(NJ), (NJ)
NJ, NJ
United States
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