Doh form 2021-2025

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4.4 out of 5

455 votes

The document is an Official New York State Prescription Registration Form required for practitioners to issue prescriptions in New York. It outlines the registration process for obtaining official prescription forms, including requirements for both new and renewal registrations, and provides instructions regarding DEA numbers and address verification. The form must be completed and submitted to the New York State Department of Health's Bureau of Narcotic Enforcement.

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Click ‘Get Form’ to open the doh form 2021 in the editor.
Begin by entering your name in the designated fields: Last, First, and Middle Initial. Ensure accuracy as this information is crucial for your registration.
Fill in your profession and New York State license number. If applicable, include your DEA registration number and NPI number.
Provide your address as it appears on your DEA registration if you are DEA registered. Otherwise, enter the address of your Primary Practice Office.
Include your city, state (NY), and zip code. Don’t forget to add a fax number and/or business email for communications from the Bureau.
Sign the affirmation section under penalty of perjury, ensuring that you use original ink only. Include the date of signing.
If you do not have a DEA number, complete the acknowledgment section requiring notarization before submission.
Once completed, save your document and follow instructions to mail it to the provided address; faxes are not accepted.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (123 Votes)
2012	4.4 Satisfied (455 Votes)
2009	4.1 Satisfied (26 Votes)

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