Contact Us Name * First Name Last Name Phone (###) ### #### Email * Provider/Team Member Select the healthcare provider or team member you would like to address Ehab F. Ibrahim, MD Roman Prager, MD Hussain Manji, MD Alla Roitman, DO Krysten Wondrack, APN Diana Garzon, Office Administrator/ Billing Ewa Slaby, APN Rose Ascencio, Practice Manager Lisa Marie Koumoulos, APN Juliana Caceres, APN Maya Moreno, APN Daenielle Taylor, APN Eulalia Leon, APN Andrea Ruiz, APN Olabisi Shade Akinmorin, APN Shahana Quadir, APN Practice Location Please select the location you are addressing Grand Avenue, Englewood, NJ West Ridgewood Avenue, Paramus, NJ Pompton Road, Haledon, NJ Summit Avenue, Hackensack, NJ Message * Privacy Statement * I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form. I CONFIRM Thank you for writing us! We take your queries with great care and will be in touch with you shortly. Thank you for trusting Advance Medical Group. We’re here for your care.
