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UBMD Orthopaedics & Sports Medicine FRM003.02-AK 2018
Get UBMD Orthopaedics & Sports Medicine FRM003.02-AK 2018-2024
/02) Claim Number: I, , ("Assignor") hereby assign to , ("Assignee") (Print patient's name) (Print hospital or health care provider name) all rights privileges and remedies to payment for health care services provided by assignee to which I am entitled under Article 51 (the No-Fault statute) of the Insurance Law. The Assignee hereby certifies that they have not received any payment from or on behalf of the Assignor and shall not pursue payment directly from the Assignor for services provided.
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Leslie Bisson, MD , Head Team Physician (voting) Thomas White, MD (voting) Andrew Cappuccino, MD. Marc Fineberg, MD. Joseph Kowalski, MD. William Wind, MD.
Marc Fineberg shares his sports medicine expertise across Western New York as Clinical Associate Professor of Orthopedic Surgery at SUNY Buffalo, Chief of Sports Medicine Service, and Team Physician to the Buffalo Bills, Buffalo Sabres, and University at Buffalo Bulls. Dr.
Marc Fineberg shares his sports medicine expertise across Western New York as Clinical Associate Professor of Orthopedic Surgery at SUNY Buffalo, Chief of Sports Medicine Service, and Team Physician to the Buffalo Bills, Buffalo Sabres, and University at Buffalo Bulls.
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