Patient Referral Form

Hernia Center
NewYork-Presbyterian Hospital/Columbia University Medical Center
Herbert Irving Pavilion
161 Fort Washington Ave (at West 165th St)

New York, NY 10032
Phone: 212.305.0319
Fax: 212.932.4328

Contact Info

(e.g. NJ) (e.g. 645-012-0000)

What Type of Insurance Do You Have?

HMO/Managed care, please specify

Traditional (indemnity), please specify

Self-pay
Medicare
Medicaid

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