NJ Department of Banking and Insurance
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Home > Insurance Division > Managed Care > Third Party Billing Services > "Doing Business As"
Adding a "Doing Business As" (DBA) or "Fictitious Business Name" for TPBs


The company shall submit the following to the Department:

  • A certified copy (full and complete set) of the fictitious name certificate or something from the domestic state acknowledging the fictitious name or dba;
  • A brief description of any other material change in the company's corporate existence prior or subsequent to the proposed addition of a dba (ie. merger, acquisition, redomestication, etc.). If none occurred, so state in the letter.
  • Biographical Affidavits for any Officer and/or Director not currently on file with the Department and a list of all officers and directors.
  • In view of the addition of a dba, confirm the following information concerning the company:
    • Federal Employer's Identification Number
    • Home Office Address
    • Mail Address
    • Telephone Number (general operator's number)
    • Effective Date of dba
    • Company President
    • Company Secretary

This information must be sent directly to the:

Department of Banking and Insurance
Attention: Third Party Billing Services, 8th Floor
PO Box 325
Trenton, NJ 08625-0325

 
 
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New Jersey Department of Banking and Insurance