h this facsimile. Thank you. EFTA00282966 Jul. 11. 2016 10:41AM No. gin r, L Name: Date of Exam: Referring Physician: Examining Physician: N. Y. Neurological Associates, P.C. Diego J. Herbstein, MD David H. Snyder, MD Emilio Oribe, MD. FACP Tanya Fatimi, MD Yvonne Zaharakis, MD Epstein. Jeffrey Date of Birth;