EFTA00313719

RECEIVED 
08/30/2017 12: 321:$1 2127174672 
71st St 
receipt 
Please return top portion with 
your payment addressed to: 
STUART 1. ORSHER. M.O.. P.C. 
DIPLOMATE. 90ARD INTEMiN. MED:CINE 
9 E 79TN ST 
NEM TCRit. NY 10075.0:23 
Mee *set 212-535.7763 
JEFFREY EPS tIN 
9 EAST 71ST STREET 
NEW YORK. NY 10021 
Please indicate any wreaths to %mit 14k.... 
Receipt date 
C8/30/20I7 
STUART I. ORSt€R. M.O.. P.C. 
Patient account a 010V4 
Patient name 
;urger EPSTEIN 
Amount due $ 
3.80 
68/33/17 
ail:/17 
08/30/17 
08/38/17 
08/30/17 
08/30/17 
08/30/17 
08/33/17 
08/30/17 
08/30/17 
00/30/17 
38/33/17 
08/30/17 
08/3C/17 
08/30/17 
08/30/17 
08/30/17 
08/30/17 
00/30/17 
PhYSIC•Att SAID:tilt 
STUAA 3814En u D 
/MATURE 
:1 
11 
11 
11 
11 
11 
11 
11 
11 
99215-2S 
93000 
94010 
60061-91 
82948 
83036 
81000 
36415 
827/0 
AM 
;$) PHYSICAL EXAM 
(S) 
It/ INTERP 
(S) KILKMART FUNCTION 
(S) LIP:0 PVC 
(S) GLUCOSE SICK TEST 
(S) GLYCOSYLATED (A1C) 
(5) LRINALYSIS-CDPLETE 
(S)vccputioun 
(S) STOOL GOAIAC 
(F) NVERICAN DRESS 
wTE 
08/30/2017 
7:-LART CASPIER. M.D.. P.C. 
EAST SEVENTY-NINTH STREET KEA- vORK. NY 1CC75.O:23 
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Receipt date 
18/30.'20:' 
Patient account if 
Patient name 
Amount due 
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845.00 
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95.00 
40.00 
45.00 
18.00 
1490.00 
RALANCEPRIORTO 0e/ /8011 
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 CHAPGES 
08/30/2017.08/30/2017$ 
1.490.00 
CREWS 
$ 
1.490.00 
- 
EFTA00313719