• Emergency Contact

  • Employment

  • Referral

  • Primary Insurance

  • Secondary Insurance

  • Signature, Privacy & Terms

  • I understand that all medical costs incurred by me are my responsibility; including any charges my insurance fails to pay. I also understand that I am responsible for any collection and/or legal efforts that may be necessary on my account.
  • I authorize payment of medical benefits to the physician for services provided.

Please be advised that as of May 1, 2021, my Chelsea, Manhattan practice and the care of my valued patients will be transferred to the physicians at ENT and Allergy Associates. To schedule your appointment you can call 212-324-9990 or you can book online, anytime, by clicking here.

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