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Form Nys 1

Form Nys 1

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Suite 195, Menands, NY 12204. If you have any questions regarding the completion of this form, you may contact us at the above noted address or call 1-800-781-2362. A physician seeking designation as an Impartial Specialist must be licensed in New York State and not have any license restrictions and/ or disciplinary actions in place or pending. The physician must be Board Certified in a medical specialty/subspecialty recognized by the American Board of Medical Specialties (ABMS) or American...
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