State Board of Medical Examiners
Change-of-Address Form for Physicians, Podiatrists and Lab Directors
13:45C-1.3(a)7 requires that all New Jersey licensees provide a timely notice of any change of address from that which appears on the licensee's most recent license renewal or application.
If your MAILING ADDRESS is not current, you will not receive your license renewal form or any other Board mailings. To ensure that you will receive all Board mailings you must immediately send the Board your current address information.
Be advised that your New Jersey licensing board/committee retains your: Home Address, Business Address and Mailing Address. One of these you determine to be your address of record. Your address of record is the address that will be printed on your renewed license certificate. Your name and this address, address of record, may also be posted as part of the Online Licensee Verification Directory. As a matter of information, under the public disclosure law as it currently stands, any of your license addresses (address of record, home, business and mailing) must be provided if requested under the Open Public Records Act. If you do not indicate an address of record, your mailing address will be considered your address of record. An address of record may be a post office box address, only if another address with a street address is provided.
This change of address form may be completed and submitted electronically by clicking the "Submit Change of Address Request" button below to meet the address reporting requirement. This form is for address change reporting only. If a duplicate license certificate with the new address is required, please mail a certified check or money order for $50.00 payable to the New Jersey State Board of Medical Examiners. Send to
New Jersey State Board of Medical ExaminersPrint your license number on the certified check or money order.
Renewal Applications Are NOT Forwarded by the Postal Service to a Forwarding Address
* = required fields