Ny is1 2026

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The document is an application form for physicians seeking designation as an Impartial Specialist by the New York State Workers' Compensation Board. It outlines eligibility requirements, including being licensed in New York, board certification, and a minimum of five years of practice in a relevant specialty. The form requires detailed personal and professional information, including office locations, tax identification number, and any previous disciplinary actions. Physicians must also confirm their active clinical practice and continuing medical education related to workers' compensation.

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Click ‘Get Form’ to open the ny is1 application in the editor.
Begin by entering your personal information in Section 1. Fill in your first name, last name, and middle initial clearly.
In Section 2, specify your medical degree by selecting either MD or DO.
Proceed to Section 3 to input your NY Medical License Number along with your date of birth and license details.
Complete Section 4 by listing your most recent board certifications, including specialty and expiration dates.
In Section 5, indicate the years of practice for each specialty you have listed.
For Section 6, provide your office locations in New York State. If necessary, attach an additional sheet.
Continue filling out Sections 7 through 17 as applicable, ensuring all responses are accurate and complete.

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2013	4.8 Satisfied (161 Votes)

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