EFTA00590320.pdf

Thomas J. Ma nani Telephone Alvin Grayson 7 West 61st Stree N pays; by croft ca.-d. emir re spurt you to pmvie 7th Floor ay our blow Nash:rued Visa Amex New York NY 10019 Card it &guitar Mr. Jeff Epstein 9 East 71st Street Date 7/29/2015 New York NY 10021 IMPORTANT • PLEASE DETACH UPPER PORTION NC RETURN PATH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits 7/1/2015 Previous Balance 7/1/2015 Recall Oral Exam 40.00 7/1/2015 Adult Scale & Prophy 180.00 Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cardsl You may complete and return the top part of this statement, or call the office at 212488-1090. Current 30 Days 60 Days 90 Days 1 220.00 0.00 0.00 j 0.00 Thomas J. MagnanIM. Alvin Grayson.... 7 West 51st Street 7th Floor New York NY 10019 (212) 688 EFTA00590320