First Name *
Last Name *
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Organization
Title
Are you a health care provider? * Yes No
If yes, what is your primary specialty? * 010-ALLERGY AND IMMUNOLOGY 020-ANESTHESIOLOGY 030-COLON AND RECTAL SURGERY 040-DERMATOLOGY 041-DERMATOPATHOLOGY 050-FAMILY PRACTICE 055-ADOLESCENT MEDICINE: FAMILY MEDICINE 056-ADOLESCENT MEDICINE: PEDIATRICS 057-BEHAVIORAL PEDIATRICS 058-INTERNAL MEDICINE AND PEDIATRICS 059-PEDIATRIC RHEUMATOLOGY 060-INTERNAL MEDICINE 061-PEDIATRIC INFECTIOUS DISEASE 062-CARDIOVASCULAR DISEASE 063-ENDOCRINOLOGY AND METABOLISM 064-GASTROENTEROLOGY 065-HEMATOLOGY - INTERNAL MED 066-INFECTIOUS DISEASES 067-NEPHROLOGY 068-PULMONARY DISEASES 069-RHEUMATOLOGY 070-NEUROLOGICAL SURGERY 071-SPINAL CORD INJURY MEDICINE 072-PEDIATRIC NEUROSURGERY 073-PEDIATRIC DERMATOLOGY 074-MEDICAL TOXICOLOGY 075-UNDERSEA & HYPERBARIC MEDICINE 076-PEDIATRIC REHABILITATION 080-NUCLEAR MEDICINE 083-NEUROMUSCULAR MEDICINE 084-NEURORADIOLOGY 085-NEUROTOLOGY 089-OBSTETRICS AND GYNECOLOGY 092-MATERNAL AND FETAL MEDICINE 093-REPRODUCTIVE ENDOCRINOLOGY 095-CERTIFIED DIABETES EDUCATOR 101-PEDIATRIC OPHTHALMOLOGY 102-CERTIFIED ASTHMA EDUCATOR 110-ORTHOPEDIC SURGERY 111-HAND SURGERY - ORTHOPEDIC SURGERY 112-HAND SURGERY - PLASTIC SURGERY 113-HAND SURGERY - SURGERY 114-PLASTIC SURGERY WITH THE HEAD & NECK 120-OTOLARYNGOLOGY 121-PEDIATRIC OTOLARYNGOLOGY 131-BLOOD BANKING 135-CLINICAL PATHOLOGY 136-FORENSIC PATHOLOGY 137-HEMATOLOGY - PSC PATH 138-CHEMICAL PATHOLOGY 139-MEDICAL MICROBIOLOGY 140-PATHOLOGY WITH MOLECULAR GENETIC SPEC 141-NEUROPATHOLOGY 142-ANATOMIC PATHOLOGY 144-TRANSPLANT HEPATOLOGY 145-PEDIATRIC TRANSPLANT HEPATOLOGY 146-ANATOMIC AND CLINICAL PATHOLOGY 147-PEDIATRIC PATHOLOGY 149-PEDIATRIC EMERGENCY MEDICINE 150-PEDIATRICS 151-PEDIATRIC CARDIOLOGY 152-PEDIATRIC HEMATOLOGY - ONCOLOGY 153-PEDIATRIC SURGERY 154-PEDIATRIC NEPHROLOGY 155-PEDIATRIC NEONATAL - PERINATAL MEDICINE 156-PEDIATRIC ENDOCRINOLOGY 157-PEDIATRIC PULMONOLOGY 160-PHYSICAL MEDICINE & REHABILITATION 161-PEDIATRIC CRITICAL CARE 162-OSTEOPATHIC MANIPULATIVE MEDICINE 163-PEDIATRIC GASTROENTOLOGY 164-CRITICAL CARE MED - ANESTHESIOLOGIST 165-CRITICAL CARE MEDICINE - INTERNAL 167-CRITICAL CARE MEDICINE - SURGERY 170-PLASTIC SURGERY 171-CLINICAL MOLECULAR GENETICS 180-CLINICAL BIOCHEMICAL GENETICS 182-GENERAL PREVENTIVE MEDICINE 183-OCCUPATIONAL MEDICINE 184-PUBLIC HEALTH - PREVENTIVE MEDICINE 187-MEDICAL GENETICS 188-CLINICAL GENETICS 189-MOLECULAR GENETIC PATHOLOGY 190-PAIN MANAGEMENT-PSYCHIATRY & NEUROLOGY 191-CHILD PSYCHIATRY 192-PSYCHIATRY 193-CHILD NEUROLOGY 194-NEUROLOGY 195-PSYCHIATRY & NEUROLOGY 197-GERIATRIC PSYCHIATRY 198-ADDICTION PSYCHIATRY 199-NERODEVELOPMENTAL DISABILITIES 201-DIAGNOSTIC RADIOLOGY 202-DIAGNOSTIC ROENTGENOLOGY 205-THERAPEUTIC RADIOLOGY 207-THERAPEUTIC RADIOLOGICAL PHYSICS 210-GENERAL SURGERY 211-HOSPITALIST 220-THORACIC SURGERY 230-UROLOGY 231-PEDIATRIC UROLOGY 240-VASCULAR NEUROLOGY 241-ONCOLOGY 242-GYNECOLOGIC ONCOLOGY 243-VASCULAR MEDICINE 244-RADIOLOGIST ONCOLOGY 245-PEDIATRIC RADIOLOGY 246-VASCULAR&INTERVENTIONAL RADIOLOGY 249-HIV PRIMARY CARE SERVICES 250-EMERGENCY MEDICINE 281-CLINICAL SOCIAL WORKER 283-COUNSELOR 290-ACUPUNCTURIST 2-RADIOLOGY 303-AIDS/HIV SERVICES 304-MEDICAL REHAB 305-PEDIATRIC SPECIALTY - ALL EXCEPT PRIMARY CARE 307-DURABLE MEDICAL EQUIPMENT 325-EARLY INTERVENTION 357-OUTPATIENT CHEMICAL DEPENDENCE WITHDRAWL 376-MENTAL HEALTH PRACTITIONER 423-DIAGNOSTIC IMMUNOLOGY - COMPREHENSIVE 429-DIAGNOSTIC IMMUNOLOGY - SPECIAL 480-HEMATOLOGY 482-HEMATOLOGY - GENERAL 516-ENDOCRINOLOGY 530-PATHOLOGY SPC 530 540-CYTOPATHOLOGY 560-GENETIC TESTING 561-BLOOD TRANSFUSION COLLECTION 562-BLOOD TRANSFUSION 601-SPORTS MEDICINE - FAMILY MEDICINE 602-SPORTS MEDICINE - INTERNAL 603-SPORTS MEDICINE - PEDIATRICS 604-SPORTS MEDICINE - ORTHOPEDIC 620-GERIATRICS - FAMILY MEDICINE 621-GERIATRICS - INTERNAL 630-PAIN MANAGEMENT 650-GENERAL VASCULARY SURGERY 651-CARDIO-THORACIC 652-INTERVENTION CARDIOLOGY 653-CLINICAL CARDIAC ELECTROPHYSIOLOGY 669-HOSPICE CARE 674-RESPIRATORY THERAPY 680-NURSING 6-SPORTS MEDICINE - EMERGENCY 716-OPTOMETRIST/DIAGNOSTIC PHARMEUTICALS 741-TRANSPLANT SURGERY 750-METHADONE MAINTENANCE (PHYSICIAN) 775-ALL SPECIALITIES 776-GENERAL PRACTICE ONLY - NO SPEC 777-ALL PHYSICIAN 778-PODIATRIST 779-NURSE PRAC 780-CLINICAL PSYCHLG 781-CERT SOCIAL WKRS 799-NO SPECIALTY REQUIRED 808-ORAL SURGEON 811-MAXILLOFACIAL SURGERY 851-OTHER VISION CARE 901-EMERGENCY ROOM 903-DIABETES 904-OBSTETRICS 905-GYNECOLOGY 906-FAMILY PLANNING 909-NUTRITION 915-ALLERGY 919-EYE/VISION CENTER 924-REHABILITATION MEDICINE- CLINIC SPECIALTY 927-CARDIOLOGY 928-CARDIOVASCULAR- CLINIC SPECIALTY 931-NEUROLOGY- CLINIC SPECIALTY 934-ONCOLOGY - THERAPY (RADIATION OR CHEMO) 937-PEDIATRIC ALLERGY- CLINIC SPECIALTY 938-PEDIATRIC NEUROLOGY- CLINIC SPECIALTY 943-PEDIATRIC ORTHOPEDIC- CLINIC SPECIALTY 945-PSYCHIATRY - INDIVIDUAL 950-ORTHOPEDIC- CLINIC SPECIALTY 952-SURGICAL, GENERAL 958-OPTHALMOLOGY - CLINIC SPECIALTY 982-APNEA CENTER 989-MEDICALLY SUPERVISED WITHDRAWAL-OUTPATIENT 999-OTHER
What is your secondary specialty? 010-ALLERGY AND IMMUNOLOGY 020-ANESTHESIOLOGY 030-COLON AND RECTAL SURGERY 040-DERMATOLOGY 041-DERMATOPATHOLOGY 050-FAMILY PRACTICE 055-ADOLESCENT MEDICINE: FAMILY MEDICINE 056-ADOLESCENT MEDICINE: PEDIATRICS 057-BEHAVIORAL PEDIATRICS 058-INTERNAL MEDICINE AND PEDIATRICS 059-PEDIATRIC RHEUMATOLOGY 060-INTERNAL MEDICINE 061-PEDIATRIC INFECTIOUS DISEASE 062-CARDIOVASCULAR DISEASE 063-ENDOCRINOLOGY AND METABOLISM 064-GASTROENTEROLOGY 065-HEMATOLOGY - INTERNAL MED 066-INFECTIOUS DISEASES 067-NEPHROLOGY 068-PULMONARY DISEASES 069-RHEUMATOLOGY 070-NEUROLOGICAL SURGERY 071-SPINAL CORD INJURY MEDICINE 072-PEDIATRIC NEUROSURGERY 073-PEDIATRIC DERMATOLOGY 074-MEDICAL TOXICOLOGY 075-UNDERSEA & HYPERBARIC MEDICINE 076-PEDIATRIC REHABILITATION 080-NUCLEAR MEDICINE 083-NEUROMUSCULAR MEDICINE 084-NEURORADIOLOGY 085-NEUROTOLOGY 089-OBSTETRICS AND GYNECOLOGY 092-MATERNAL AND FETAL MEDICINE 093-REPRODUCTIVE ENDOCRINOLOGY 095-CERTIFIED DIABETES EDUCATOR 101-PEDIATRIC OPHTHALMOLOGY 102-CERTIFIED ASTHMA EDUCATOR 110-ORTHOPEDIC SURGERY 111-HAND SURGERY - ORTHOPEDIC SURGERY 112-HAND SURGERY - PLASTIC SURGERY 113-HAND SURGERY - SURGERY 114-PLASTIC SURGERY WITH THE HEAD & NECK 120-OTOLARYNGOLOGY 121-PEDIATRIC OTOLARYNGOLOGY 131-BLOOD BANKING 135-CLINICAL PATHOLOGY 136-FORENSIC PATHOLOGY 137-HEMATOLOGY - PSC PATH 138-CHEMICAL PATHOLOGY 139-MEDICAL MICROBIOLOGY 140-PATHOLOGY WITH MOLECULAR GENETIC SPEC 141-NEUROPATHOLOGY 142-ANATOMIC PATHOLOGY 144-TRANSPLANT HEPATOLOGY 145-PEDIATRIC TRANSPLANT HEPATOLOGY 146-ANATOMIC AND CLINICAL PATHOLOGY 147-PEDIATRIC PATHOLOGY 149-PEDIATRIC EMERGENCY MEDICINE 150-PEDIATRICS 151-PEDIATRIC CARDIOLOGY 152-PEDIATRIC HEMATOLOGY - ONCOLOGY 153-PEDIATRIC SURGERY 154-PEDIATRIC NEPHROLOGY 155-PEDIATRIC NEONATAL - PERINATAL MEDICINE 156-PEDIATRIC ENDOCRINOLOGY 157-PEDIATRIC PULMONOLOGY 160-PHYSICAL MEDICINE & REHABILITATION 161-PEDIATRIC CRITICAL CARE 162-OSTEOPATHIC MANIPULATIVE MEDICINE 163-PEDIATRIC GASTROENTOLOGY 164-CRITICAL CARE MED - ANESTHESIOLOGIST 165-CRITICAL CARE MEDICINE - INTERNAL 167-CRITICAL CARE MEDICINE - SURGERY 170-PLASTIC SURGERY 171-CLINICAL MOLECULAR GENETICS 180-CLINICAL BIOCHEMICAL GENETICS 182-GENERAL PREVENTIVE MEDICINE 183-OCCUPATIONAL MEDICINE 184-PUBLIC HEALTH - PREVENTIVE MEDICINE 187-MEDICAL GENETICS 188-CLINICAL GENETICS 189-MOLECULAR GENETIC PATHOLOGY 190-PAIN MANAGEMENT-PSYCHIATRY & NEUROLOGY 191-CHILD PSYCHIATRY 192-PSYCHIATRY 193-CHILD NEUROLOGY 194-NEUROLOGY 195-PSYCHIATRY & NEUROLOGY 197-GERIATRIC PSYCHIATRY 198-ADDICTION PSYCHIATRY 199-NERODEVELOPMENTAL DISABILITIES 201-DIAGNOSTIC RADIOLOGY 202-DIAGNOSTIC ROENTGENOLOGY 205-THERAPEUTIC RADIOLOGY 207-THERAPEUTIC RADIOLOGICAL PHYSICS 210-GENERAL SURGERY 211-HOSPITALIST 220-THORACIC SURGERY 230-UROLOGY 231-PEDIATRIC UROLOGY 240-VASCULAR NEUROLOGY 241-ONCOLOGY 242-GYNECOLOGIC ONCOLOGY 243-VASCULAR MEDICINE 244-RADIOLOGIST ONCOLOGY 245-PEDIATRIC RADIOLOGY 246-VASCULAR&INTERVENTIONAL RADIOLOGY 249-HIV PRIMARY CARE SERVICES 250-EMERGENCY MEDICINE 281-CLINICAL SOCIAL WORKER 283-COUNSELOR 290-ACUPUNCTURIST 2-RADIOLOGY 303-AIDS/HIV SERVICES 304-MEDICAL REHAB 305-PEDIATRIC SPECIALTY - ALL EXCEPT PRIMARY CARE 307-DURABLE MEDICAL EQUIPMENT 325-EARLY INTERVENTION 357-OUTPATIENT CHEMICAL DEPENDENCE WITHDRAWL 376-MENTAL HEALTH PRACTITIONER 423-DIAGNOSTIC IMMUNOLOGY - COMPREHENSIVE 429-DIAGNOSTIC IMMUNOLOGY - SPECIAL 480-HEMATOLOGY 482-HEMATOLOGY - GENERAL 516-ENDOCRINOLOGY 530-PATHOLOGY SPC 530 540-CYTOPATHOLOGY 560-GENETIC TESTING 561-BLOOD TRANSFUSION COLLECTION 562-BLOOD TRANSFUSION 601-SPORTS MEDICINE - FAMILY MEDICINE 602-SPORTS MEDICINE - INTERNAL 603-SPORTS MEDICINE - PEDIATRICS 604-SPORTS MEDICINE - ORTHOPEDIC 620-GERIATRICS - FAMILY MEDICINE 621-GERIATRICS - INTERNAL 630-PAIN MANAGEMENT 650-GENERAL VASCULARY SURGERY 651-CARDIO-THORACIC 652-INTERVENTION CARDIOLOGY 653-CLINICAL CARDIAC ELECTROPHYSIOLOGY 669-HOSPICE CARE 674-RESPIRATORY THERAPY 680-NURSING 6-SPORTS MEDICINE - EMERGENCY 716-OPTOMETRIST/DIAGNOSTIC PHARMEUTICALS 741-TRANSPLANT SURGERY 750-METHADONE MAINTENANCE (PHYSICIAN) 775-ALL SPECIALITIES 776-GENERAL PRACTICE ONLY - NO SPEC 777-ALL PHYSICIAN 778-PODIATRIST 779-NURSE PRAC 780-CLINICAL PSYCHLG 781-CERT SOCIAL WKRS 799-NO SPECIALTY REQUIRED 808-ORAL SURGEON 811-MAXILLOFACIAL SURGERY 851-OTHER VISION CARE 901-EMERGENCY ROOM 903-DIABETES 904-OBSTETRICS 905-GYNECOLOGY 906-FAMILY PLANNING 909-NUTRITION 915-ALLERGY 919-EYE/VISION CENTER 924-REHABILITATION MEDICINE- CLINIC SPECIALTY 927-CARDIOLOGY 928-CARDIOVASCULAR- CLINIC SPECIALTY 931-NEUROLOGY- CLINIC SPECIALTY 934-ONCOLOGY - THERAPY (RADIATION OR CHEMO) 937-PEDIATRIC ALLERGY- CLINIC SPECIALTY 938-PEDIATRIC NEUROLOGY- CLINIC SPECIALTY 943-PEDIATRIC ORTHOPEDIC- CLINIC SPECIALTY 945-PSYCHIATRY - INDIVIDUAL 950-ORTHOPEDIC- CLINIC SPECIALTY 952-SURGICAL, GENERAL 958-OPTHALMOLOGY - CLINIC SPECIALTY 982-APNEA CENTER 989-MEDICALLY SUPERVISED WITHDRAWAL-OUTPATIENT 999-OTHER
In which borough do you primarily practice? * Long Island New York State (non-city) Tri-State (CT or NJ) Bronx Brooklyn Manhattan Queens Staten Island
If no; where are you located? * New York City only The Tri-State Area (NJ, NY, CT), not including New York City. Outside of the Tri-State Area (NJ, NY, CT)
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