Registration

We are not able to find your record in the system. Please email us at ProviderDirectory@health.ny.gov if you have registered before. Otherwise, please visit here to register.

Attestation
Clinical/Provider Service Type Information 
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Service Type:
(Please note that only one service type can be selected at a time)
Clinical/Provider Contact Information
 
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   Yes
Certification Name Certification Date
Population Served:
  •    
  •    
  •    
 


Please complete the following questions
PrEP & PEP
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 Yes    No 
 
   
 Yes    No 
   
 Yes    No 
Buprenorphine
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 Yes    No 
HIV
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HCV
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Individual Provider Attestation: 


 Yes    No 
     
STI
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 Yes    No 


 Yes    No 
PEP Hotline Network
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 Yes    No 
Naloxone Pharmacy
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 Yes    No    

Facility/Practice Site Information
    click "plus" to add more practice sites
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Facility Address
 






 
Best method to contact for appointments:



For ESAP Service Only
 



Invite a Colleague 
   Yes
Enter their information below and we will invite them to register.

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