EFTA02335953

STATEMENT Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 Jeff Epstein 9 East 71st Street New York NY 10021 Telephone: If paying by cr.& card. infer Ike anwunl tau are pating n me ranallance box and fill oul below Meilercard Visa Amex Card ■ Exp Dale Samba, Sig Code Date Account 3/30/2016 3114 Remittance IMPORTANT - Pt rate DETACH UPPER PORTION AND RETURN MN YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/2/2016 Previous Balance 0.00 3/7/2016 Jeff Temporary Cement 375.00 375.00 3/30/2016 Jeff 1 Surface Comp. Posterior 425.00 800.00 6 it ' a r C Account Total 800.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete op part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 800.00 0.00 0.00 0.00 0.00 Thomas J. Magnani O.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA_R1_01294904 EFTA02335953 From Subject: Jeffrey and doctors-Wed. March 30th, 2016 Date: March 29, 2016 at 11:39 AM To: Bella Klein bklinn575@gmail corn FYI...Jeffrey is going to see Dr. Magnani tomorrow at 9am and Dr. Kline at 10am (Magnani for a cavity and Kline is a dermatologist) EFTA_R1_01294905 EFTA02335954