Contents

Practice Information  (Optional.------ If completed, the information provided will be made public.)


Medical Doctors and Podiatrists: Enter information about your practice(s). 
     If you practice at more than one office, list in order of where you practice most often. A practice name is required to save any practice information.


Optometrists: The practice address(es) listed below here cannot be changed. 
     If any practice address information is incorrect, please contact the New Jersey State Board of Optometrists at PO Box 45012, Newark, NJ 07101.


Enter information about your practice(s). If you practice at more than one office, list in order of where you practice most often.
  • Practice Name (Optional. If completed, the information provided will be made public) …..Enter name of practice.
  • Address (Required)  Enter address of practice (3 lines).
  • City (required) Enter the city of the practice.
  • State (USA Only) (required) Click on the arrow; select state
  • Zip/Postal Code (Required) Enter postal zip code.
  • Phone Number (Optional. if completed, the information provided will be made public) Enter phone number.
  • County (Required)
  • Office Hours (Optional. If completed, the information provided will be made public) Enter hours that your practice is open.
  • Government Programs 
  • Indicate if you participate in the Medicaid program.
  • Indicate if you accept Medicare assignment.
  • Indicate if your office is accessible to people with disabilities.


    Translation Services 
  • Indicate which languages by clicking in the box next to the languages that apply. (Click again to de-select).
  • If other languages are available but not listed, enter the language(s) in the box provided.


    When finished, click one of the buttons at the bottom of the screen:
  • Save & go to previous page
  • Save & stop for now
  • Save & go to next page