N.J. Admin. Code § Tit. 11, ch. 3, subch. 25, app B

Current through Register Vol. 56, No. 21, November 4, 2024

Appendix B

Address for Notification of Commencement of Medical Treatment

Insurance Co. Name: ......................................................

NAIC Group #: .......................

NAIC Company #: .....................

Address established by insurer for the filing of the notification of

the commencement of PIP treatment by Treating Health Care Providers

Address:	.................................................................
.................................................................
.................................................................

Facsimile Number: ........................................................

E-mail: ..................................................................

Contact Person: ..........................................................

Phone: ...................................................................

N.J. Admin. Code Tit. 11, ch. 3, subch. 25, app B

Amended by R.1998 d.591, effective 12/21/1998 (operative March 22, 1999).
See: 30 New Jersey Register 3202(a), 30 New Jersey Register 4390(b).
Substituted a reference to Treating Health Care Providers for a reference to Treating Medical Providers.