Get Ny Doh-4329 2021-2025

Filling out the NY DOH-4329 form is essential for practitioners seeking to register for Official New York State Prescriptions. This guide provides clear, step-by-step instructions to assist you in completing the form accurately online.

Follow the steps to successfully complete your registration form.

1. Press the ‘Get Form’ button to acquire the form and open it in the required editor.
2. Fill in the practitioner’s name, including last name, first name, and middle initial. Specify your profession and specialty using the provided list.
3. Enter your New York State license number. If you are a physician assistant, ensure to attach the completed DOH-5054 form.
4. For those with a DEA registration number, input it here. If applicable, also include your National Provider Identifier (NPI) number.
5. Provide your practitioner's address. If you are DEA registered, ensure that the address matches your DEA documentation. If you are not DEA registered, enter the address of your primary practice office.
6. Fill out your contact information, including your phone number, fax number, and both your practitioner’s and business email addresses.
7. Complete the Affirmation section by signing in original ink and dating the form. This is a declaration that the information provided is true.
8. If you do not have a DEA number, ensure to complete the Acknowledgement section which requires a notary signature and stamp.
9. Review the completed form for accuracy. After verifying all information, you may save the changes, download, print, or share the form as needed.

Take action now and complete your NY DOH-4329 registration form online.