EFTA Document EFTA01355604

O• 0 zz m O 0 mm zz —I r• r — r -D XO C 03 C -4 -4 C T1 m O ?) C) cp Dc 0) Z • 0 cp O 0 C Z I -< 0 I o No. Full Name Address/Phone SSN SUFFOLK COUNTY (0611997.03/2013) ;Hotel or Motel ADLER NI MD PAIN MANAGEMENT (Omani Cling Name) 14 NIGHTINGALE CT MANHASSET. NY 11030.4039 NASSAU COUNTY "O12) (Current Letting Name) 37 DAVISON LN E WEST ISLIP. NY 11795-5201 SUFFOLK COUNTY (07/1990477/1999) 134 DONISON AVE WEST ISLIP. NY 11795 SUFFOLK COUNTY (1I/1997-11)1997) 735 MONTAUK HWY STE A WEST ISLIP. NY 11795-49O1 SUFFOLK COUNTY (09/1996-02)1997) 135 AMITY ST APT 1C BROOKLYN. NY 112O1.6176 KINGS COUNTY (12J1988-0301994) 280 E MAIN ST BAY SHORE. NY 11106.8403 SUFFOLK COUNTY (01/1990-12/1990) 139 BERGEN AVE WEST BABYLON. NY 11704-6401 SUFFOLK COUNTY (1111989.1O1989) Page 3 3. EPSTEIN. JEFFREY M 11 INDEPENDENCE CT 13O48-XXXX EPSTEIN, JEFFREY NEW CITY. NY 10956-6902 (NY:1971) ES PTEIN. JEFF M ROCKLAND COUNTY (Gender Male) tnI) Lex1D(sm):000752553365 (DOB: 06/1956) (Age: 56) EPSTEIN JEFFREY (O8/1997-Currenl) .1BR Research Profik modified 6' 152007 26 LEROY ST APT 1FN NEW YORK. NY 19014-3940 NEW YORK COUNTY (03r2012-02/2013) 296 NORTHERN BLVD APT GREAT NECK, NY 11021.4706 NASSAU COUNTY (04/2007434/2007) 77 HAMILTON RD MONTICELLO. NY 12701.3647 SULLIVAN COUNTY (10.2006-10/2006) last • 2 --J 0 For internal we only EFTA01355604