Case File
efta-efta01118550DOJ Data Set 9OtherSamuel C. Klagsbrun, M.D.
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01118550
Pages
1
Persons
0
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Samuel C. Klagsbrun, M.D.
595 Madison Avenue
Suite 2000
New York, NY 10022
BILL TO/PATIENT:
license #0905,5
$00 Cross River Road
Katonah. NY 10536
STATEMENT PERIOD:
July 1, 2011 - July 31, 2011
For professional services:
Date
Description
Amount
07/01/201-1
07/05/2011
Previous balance
1
N c>.c -1 (...:-
, I t
$
400.00
400.00
07/12/2011
>e cm
400.00
07/19/2011
400.00
07/28/2011
400.00
Balance due
$
2000.00
Provider Tax ID 132698221
Diagnosis: 309.24
Provider NPI 1508083437
Please remit your payment within 30 days, payable to DR. KLAGSBRUN. Most major credit cards accepted. If you
have any questions, please call Renee Sibrizzi at
ext. 2222. Thank you.
EFTA01118550
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Phone
2698221Phone
8083437Forum Discussions
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