Where Special Concerns    Deserve Special Care
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83 Summit Avenue
Hackensack, NJ 07601
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19 Spear Road, Route 17 North
Ramsey, New Jersey 07446
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481 Hackensack Avenue
Hackensack, NJ 07601
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One Bridge Plaza
Fort Lee, NJ 07024
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Make an Appointment
To arrange for a confidential appointment with one of our providers, please complete this form and send it to stadocs@hotmail.com or have this information readily available when you call to schedule an appointment.

* = Required Information

* Name
Address
City, State, Zip Code
Home Phone
Work/Cell Phone
* Email Address
Insurance Data:
Name of Insurance Company

Insurance company's toll free
number to verify eligibility or benefits

Name of Insured
Insured's date of birth
Insured's social security number
Insured's identification number

Insured's place of employment

Insured's Group number
Relationship to Insured
If you are not the insured:
Your date of birth
Your Social Security Number
All information provided is transferred to a secure site and your personal information will not be shared outside of our organization.