Patient Information

Patient Name: *

Invoice Number: *

* Please refer to the Invoice Number located on your bill under the word “Invoice”

 

Payment Information

Payment Amount: *

Cardholder Email: *

Cardholder Phone: *

When you click the PayNow button, you will be redirected to www.paypal.com to finalize and process your payment.
* asterisk denotes required fields    

     

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Payments by Mail

Mail payment check to :
LICENT
PO Box 263
Jericho, NY 11753-0263
 

Telephone Payments

Call the office 5162221105 and pay over the phone using your credit card.
 

Online Payments

Our online Bill Pay feature utilizes PayPal’s credit card processing system. A PayPal account is not required to process your payment.

PayPal accepts all major credit/debit cards. For more information, please visit www.paypal.com.

How it Works

When you make a payment using PayPal, your credit card information will not be stored by or provided to Long Island Center for Ear Nose and Throat Health. All credit card processing is handled through PayPal. By entering your email address, a copy of your receipt will be delivered to you directly. We encourage you to print and save this receipt for your records. If you encounter any payment problems you will need to provide the Transaction ID in order for us to assist you.

If you have any questions regarding the use of our forms please contact our office during normal business hours.