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NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW VERIFICATION OF TREATMENT BY ATTENDING PHYSICIAN OR OTHER PROVIDER OF HEALTH SERVICE (This form is not for verification of hospital treatment ) NAME AND ADDRESS OF INSURER OR
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Document Date: 2011-10-01 14:42:59


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Company

SERVICE IS A PROFESSIONAL SERVICE CORPORATION / /

Currency

USD / /

Facility

Print hospital / /

IndustryTerm

SERVICES / health services / health care services / /

MedicalCondition

injuries / /

Organization

Print hospital / HEALTH CARE SERVICE / PROVIDER OF HEALTH SERVICE / WCB / /

Position

CONTRACTOR / REPRESENTATIVE / ATTENDING PHYSICIAN / /

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