Kamran Fallahpour, PhD 263 Westend Ave Suite 1D New York, NY 10023 Bill To: ea Bill as of : Apr 10, 2014 Date Transaction 4/9/2014 Clinical Intakes Psychiatric Evaluatic 4/9/2014 Payment - Bill For: CPT Code Diagnosis Total Owed 90792 $3,500.00 ($3,500.00) $0.00 Please Pay this Amount: Charges for services to be rendered, please pay balance before neurological testing appointment. Kamran Fallahpour, PhD License Number: 015910 Tax Id NPI: 1 EFTA00602690

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Kamran Fallahpour, PhD 263 Westend Ave Suite 1D New York, NY 10023 (212)877-2130 Bill To: Bill For: Bill as of : Apr 10, 2014 Date Transaction CPT Code Diagnosis Total Owed Kamran Fallahpour, PhD License Number: 015910 Tax I NPI: I EFTA00602691