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ABOUT
PROVIDERS
Doctors
Dr. Oladapo M. Babatunde, MD, FAAOS
Dr. Marco Lawandy, DO, MS
Dr. Jason Hymowitz, DPM, FACFAS, DABPM
Physician Assistants
Catherine Elias, MS, PA-C
Antonio Kamel, MS, PA-C
CONDITIONS
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Hip Conditions
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Foot & Ankle Conditions
Nerve & Pain Conditions
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PROCEDURES
Knee Procedures
Hip Procedures
Shoulder & Elbow Procedures
Hand & Wrist Procedures
Foot & Ankle Procedures
Nerve & Pain Procedures
Back & Neck Procedures
PROTOCOLS
LOCATIONS
East Rutherford New Jersey Office
West Orange New Jersey Office
Paramus New Jersey Office
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CONTACT
Physical Therapy Authorization Request
Dr. Oladapo Babatunde
2024-08-19T13:18:57-04:00
COSM Physical Therapy Authorization Request Form
Please Use This Form To Submit Physical Therapy Authorization Requests.
Please allow 7 Business Days for Processing.
If You Need Records Expedited, Please Call Our Office at
201-500-9450
.
Patient Name
*
First
Patient Date Of Birth
*
Requestor Name
*
First
Requestor Company
*
Requester Phone
*
Requestor Fax
*
Requestor Email
*
CPT Codes To Authorize
*
97110
97140
97014
97112
97010
97164
97530
97535
97162
G0283
OTHER
OTHER CODES REQUESTED
PLEASE UPLOAD YOUR PATIENT TREATMENT NOTES YOUR REQUEST WILL NOT BE PROCESSED. WE NEED THESE TO SUBMIT THE AUTHORIZATION
*
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 10 MB.
