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NYU Langone Department of Orthopedic

Orthopedic Surgery GRADUATE AT NYU LANGONE HEALTH

DC 9/14/2020 For more than 150 years, one of the central missions are proud to be able to educate learners at all levels, INTRODUCTION A PROUD HISTORY OF of our department has been the education, training, including those in clinical practice and in state-of- ACADEMIC EXCELLENCE and mentoring of orthopedic . Our the-art facilities, while also providing access to the In 1997, the departments of orthopedic surgery at department boasts academic medical programs at most up-to-date surgical technologies, in many cases the for Diseases (now NYU Langone The NYU Langone orthopedic education programs every level, from undergraduate to first year medical developed by our own faculty. Orthopedic Hospital) and NYUMedical Center (now are rooted in the very origins of orthopedic educa- student to chief resident, and from clinical fellows to NYU Langone Health), created a single orthopedic tion in this country. visiting clinicians from around the world. However, access to 21st century technology is not the surgery and program that most important resource we provide. What makes combined the academic excellence and traditions Orthopedic education at the NYU Grossman The goals of our residency and fellowship training our programs unique is the world-class faculty of 182 of two historic institutions. Today, the Department School of traces its origins to the nine- programs are the following: to provide our trainees orthopedic surgeons and scientists, at the pinnacle of Orthopedic Surgery at NYU Langone Health teenth century and its long-term association with with the tools to master the rigors of clinical training, of their respective , who are available boasts the largest, and one of the most prestigious, Bellevue Hospital. When Dr. Lewis Albert Sayre to introduce students and trainees to the principles of to share their accrued knowledge with each incoming orthopedic residency programs in the nation. In was appointed Professor of Orthopedic Surgery, sound orthopedic science, non-technical skills, and— learner. Whether the field is or pediatric addition, we offer fellowship programs in every major Fractures, and Dislocations at Bellevue in 1853, it most importantly—to provide them with an extensive orthopedics, shoulder and elbow or foot and ankle, orthopedic while providing educational represented the first orthopedic professorship in patient care experience, in the operating room, in there are multiple faculty members available with the opportunities for undergraduate students, medical North America. Dr. Sayre held this title, and later the emergency department and in many different expertise necessary to train our students, residents, students and orthopedic surgeons from the United that of Professor of Clinical Surgery, until 1898, outpatient settings. We do this in an environment fellows and visiting clinicians in every aspect of States and around the world. when Bellevue Hospital Medical College merged that promotes a variety of learning experiences and orthopedic care. with University Medical College of NYU to become professional training across all the major orthopedic the New York University School of Medicine. Dr. subspecialties while at the same time allowing Reading through the following pages, we are reminded of Sayre trained many of the country’s first orthope- individuals to grow and develop the skills necessary to the numerous surgeons who have trained in our programs dic surgeons, thus making ours the oldest such become future leaders of our field. and we are gratified by their professional success. But orthopedic training program in the . we are not content to rest on our reputation—in the Orthopedic surgery is a discipline that does not coming years we look forward to expanding our academic The history of the the Hospital for Joint Diseases stand still in this era of rapidly evolving medical programs even further, as we train an ever more diverse begins in 1905, when brothers Drs. Henry and Her- technology and our programs expose trainees to the group of future surgeons, researchers and leaders in the man Frauenthal, founded the Jewish Hospital for latest advancements in orthopedic techniques. We field of orthopedic surgery. Deformities and Joint Diseases with a mission to help children with infantile paralysis. The highlights of the Hospital for Joint Diseases’ early history in- cludes the first research on arthroscopic techniques Eric J. Strauss, MD Mara Karamitopoulos, MD in the United States, the development of surgical Associate Professor Associate Professor procedures for the treatment of and congenital Program Director Associate Residency Program Director deformities in children, the establishment of ortho- Orthopedic Residency pedic as a distinct subspecialty and the Department of Orthopedic Surgery establishment of the first orthopedic biomechanics laboratory in the United States. Ran Schwarzkopf, MD Kenneth A. Egol, MD Associate Professor Professor & Vice Chair of Most recently the combined institutions opened Associate Residency Program Director Academic Affairs the largest state-of-the-art facility for treating Department of Orthopedic Surgery musculoskeletal conditions in New York City, the NYU Langone Orthopedic Center (LOC).

Joseph D. Zuckerman, MD The education and mentoring of future generations Professor & Chairman of surgeons has been the mission of both institu- Department of Orthopedic Surgery tions from their inception. As the oldest and largest such program, we continue to strive for excellence within this domain.

DC 9/14/2020 THE RESIDENCY PROGRAM Year One Residents will become more actively involved The first residency year is a combined medical in the development of treatment plans for both Every year the Department of Orthopedic Surgery and surgical experience with rotations in a surgical outpatients and inpatients, while moving into selects 14 new residents from a pool of more skills “boot camp,” , , the roles of primary and first assistant than 600 applicants for a fully accredited, 5-year , adult reconstructive surgery, in the operating room. Fourth-year residents are residency program. The goal is for residents to orthopedic trauma surgery, general orthopedics, expected to make the transition to a more senior gain the necessary knowledge and experience and pediatric orthopedic surgery. In addition, role on the care team. to successfully complete the certifying exams rotations in the intensive care unit and the of the American Board of Orthopaedic Surgery emergency room are also included. Year Five and to enter the practice as well-trained, highly During the final training year residents function competent orthopedic surgeons. Year Two as the chief resident of a multiple-resident Second-year rotations offer experience in service, which varies from two to six residents Recognized as one of the finest educational managing different orthopedic conditions in both depending on the rotation. Fifth-year residents are experiences available in the field, our residency outpatient and inpatient settings. Second-year responsible for all clinical activities of the service, program at NYU Grossman School of Medicine residents provide orthopedic consultations in including inpatient and outpatient care, as well as is accredited by the Accreditation Council for NYU Langone’s emergency rooms. The operating all operating room activity. The coordination of Graduate Medical Education (ACGME). There room experience emphasizes acquiring basic all resident and fellow activity and the oversight are 72 residents in the program at any given psychomotor technical skills and learning the of the care provided are the responsibility of the time. Two residents are selected into a clinician– fundamental principles of anatomy, surgical senior residents. Fifth-year residents work directly scientist training program and spend an extra dissection, and orthopedic surgery. During each with the chief of service and other members of the year performing full-time research. Residents rotation, residents serve as the junior resident of a teaching faculty and serving as primary surgeon spend 60 months on clinical rotations, which clinical service while developing basic orthopedic and first assistant in the operating room. include all major subspecialty areas of orthopedic knowledge, which is paramount during this year. surgery: adult reconstructive surgery, foot and recommended by the American Academy of ankle surgery, hand surgery, orthopedic , Orthopaedic Surgeons (AAOS). All residents are Year Three THE CLINICIAN SCIENTIST pediatric orthopedic surgery, shoulder and elbow required to complete a minimum of three writing At this point in the program, residents should have TRAINING PROGRAM surgery spine surgery, , and projects to demonstrate scholarly activity, one of the knowledge and experience to more actively direct trauma and fracture surgery. which must be an original basic science or clinical the care of patients. On some rotations, residents Since 1984, our department has offered an additional research project. Book chapters, review articles, report directly to a fellow or to the attending year of training for those interested in pursuing a Residents in the program gain experience in both and other scholarly activities, such as video faculty. In the third year, the focus is on completing career as a clinician scientist. Each year, two medi- outpatient and inpatient settings and are trained in projects, may fulfill the other two requirements. orthopedic subspecialty rotations, which helps cal students entering the residency program are operative and nonoperative treatments for a wide residents consider which subspecialty fellowship to accepted into the 6-year Clinician Scientist Training variety of orthopedic conditions. Members of the pursue. Experience in both inpatient and outpatient Program. The goal of the 6-year research program is large teaching faculty provide close interaction and ORTHOPEDIC SURGERY RESIDENCY care, as well as in the operating room, increases to immerse the resident in an intensive year of clinical supervision. Faculty also offer weekly case confer- TRAINING EXPERIENCE at this level. Residents actively participate in more and basic science orthopedic research. This program ences for each clinical rotation. and increasingly complex cases, which provides is designed for those interested in an academic ca- Training in our program is based on the principle preparation for the senior resident years. reer focused on leadership and scientific discovery. Clinical training is enhanced by a comprehensive of increasing responsibility as you gain knowledge didactic program that includes conferences in and experience in each rotation. Year Four This program is a rewarding experience that all areas of clinical orthopedics, fractures, basic Responsibility for patient care continues to introduces future clinician-scientists to a wide range science, and orthopedic pathology. Based on a Clinical rotations take place in several locations, increase, and in some rotations, residents report of orthopedic research. This 12-month program takes two-year cycle, the didactic program provides each including NYU Langone Orthopedic Center (LOC), directly to the fellows and attending staff. Although place within the Musculoskeletal Research Center resident with at least two complete cycles during NYU Langone’s Tisch Hospital, the Kimmel Pavil- the fifth-year resident on each service is the chief (MRC) and begins in July of the R3 year for those the five years of orthopedic training. ion, NYU Langone Orthopedic Hospital (LOH), NYU resident, fourth-year residents have specific residents selected. Residents are assigned a focus Langone Hospital—Brooklyn, Hassenfeld Children’s clinical responsibilities in which they may function in basic science and clinical investigations under the Research scientists and clinical faculty Hospital at NYU Langone, VA NY Harbor Healthcare as the supervising resident. This year of training is mentorship of Philipp Leucht, MD, PhD, Director of work together to provide a thorough basic System, NYC Health + /Bellevue (BHC). a pivotal shift from junior to senior resident, and Orthopedic Research. science didactic curriculum based on the one and Jamaica Hospital Medical Center. expectations and responsibilities grow accordingly. DC 9/14/2020 Division of Sports Medicine Orthopedic Surgery. It is open to who (two positions) have completed an accredited residency program in , , , or . Fellows develop expertise in the area of primary care sports medicine including the diagnosis and management of musculoskeletal , musculoskeletal ultrasound, medical prob- lems related to sports participation, sports concus- sion, and procedures including injection and casting. They participate in weekly journal Laith M. Jazrawi, MD - Director clubs and didactics, and treat patients in the outpa- Michael J. Alaia, MD - Co-director tient setting, the collegiate athletic training room, Fellows in the sports medicine program become and other subspecialty while also gaining knowledgeable in all aspects of Sports Medicine experience with sideline coverage and mass event including prevention, diagnosis, treatment and coverage with professional sports teams, collegiate rehabilitation of the injured athlete. Medical Division I and Division III athletics, high school At the conclusion of the research year, the resident Division of Spine Surgery coverage of high school, college (Division 1 and football and rugby, and the New York City Marathon will have gained an in-depth experience in biome- (five positions) Division 3 athletics) and professional teams and other race events. chanical or biomolecular techniques used in con- (Jacksonville Jaguars Football Team) provides for temporary orthopedic research and have greater intimate involvement of major sports injuries as Division of Hand Surgery insight into today’s relevant research topics. well as training room experience. The fellowship (five positions) includes an extensive experience in arthroscopic Each research resident is responsible for the planning, surgery of the shoulder, elbow, knee, hip and initiation, execution, and manuscript submission of ankle as well as advanced reconstructive surgery at least one clinical and one basic research investiga- including complex instability procedures and tion; participating in ongoing studies conducted by the shoulder . In addition, fellows will get MRC’s faculty; preparing and presenting the results of Jeffrey A. Goldstein, MD – Fellowship Director experience in joint preservation including complex studies in which he/she is involved at national meet- Charla Fischer, MD – Associate Fellowship Director and transplantation. There is ings; and researching and preparing at least one com- The spine fellowship is designed for five fellows ample opportunity for and emphasis on both clinical prehensive review paper, typically on a controversial from the US and internationally. The fellowship is and basic science research. Applicants must have Louis W. Catalano, MD – Director subject, for publication in a major orthopedic journal. accredited by the ACGME. There are several di- completed an accredited orthopedic residency Martin Posner, MD – Director Emeritus The resident will work under the guidance of the MRCs versely trained subspecialty spine surgeons directly program at the time the fellowship begins. The Combined Emanuel/Eaton Hand Fellowship research faculty, an outstanding group of full-time involved in the fellowship program. The fellows are is a diverse experience devoted to the treatment scientists who mentor the residents in the program. exposed to a wide range of pathology including Division of Primary Care Sports Medicine of disorders of the hand, wrist, and elbow. Fellows degenerative spine disease, complex pediatric and (one position) assist in the care provided at two weekly clinics adult deformity cases, tumors, trauma, revisions, and present at weekly conferences along with FELLOWSHIP PROGRAMS and . At the end of the fellowship, fellows the residents. The experience includes office will be trained in surgery from the occiput to the management and operative intervention of such Fellows in the Department of Orthopedic Surgery sacrum, both anterior and posterior, with and with- disorders as compressive neuropathies, trauma, work closely with the resident staff and function as out instrumentation. Fellows are exposed to many arthritis, tendonitis, and rheumatoid deformities. junior attendings. All fellows are expected to pursue new and cutting edge surgical techniques such as The fellows work at LOH, LOC, Jamaica and BHC as at least one scholarly activity during the year and disc arthroplasty, minimally invasive surgery, and well as at affiliated institutions at the discretion of must present the results of their work at a depart- robotics and navigation as well as a robust research the program director. mental meeting, prior to completion of their fellow- program. The fellows train at the main NYU Langone Dennis A. Cardone, DO – Director ship year. Each fellow is responsible for participation campus which includes the new Kimmel Pavillion. Lauren Borowski, MD – Associate Director in the resident curriculum lecture series. Seven This one-year primary care sports medicine fel- orthopedic subspecialties offer 21 postgraduate lowship combines the resources of NYU Langone’s fellowship-training positions that provide a compre- Department of Pediatrics and the Department of hensive clinical experience in each of these areas: DC 9/14/2020 Division of Adult Reconstructive Surgery and mortality conferences, and sports medicine have a faculty sponsor within the department. cellular biomechanics, regeneration, and repair. (6 positions) conferences. A typical weekly schedule consists The sponsor will guide the VIP’s experience and The primary lab for the MRC is a 4,000-square-foot of attending shoulder and elbow, sports medicine, help the VIP obtain the educational experience facility that houses a “materials testing” laboratory, and department-wide academic conferences; he/she desires. Length of visit, the location of the cell and molecular biology laboratory, histology providing care in our outpatient ambulatory observership, and the specific activities the VIP will laboratory, tissue culture facilities, and a microscopy care center and office sites; performing surgical engage in are agreed upon by the VIP and his/her laboratory. In 2017, we expanded our research procedures under the guidance of our core faculty faculty sponsor before the visit takes place. facilities to the NYU Tandon School of Engineering members; and engaging in scientific research. with a combined laboratory in the 26th Street facility. In addition, there are many opportunities for Division of Pediatric Orthopedic Surgery RESEARCH AND SURGICAL collaboration within NYU Langone Health including James Slover, MD – Director (one position) TRAINING FACILITIES collaborative research with staff at the departments The NYU/ISK Adult Reconstructive Fellowship of Population Health, Cell Biology, Medicine as well Program is designed to provide extensive clinical The Musculoskeletal Research Center as researchers from the NYU School of . experience in primary and revision knee and hip Research is one of the cornerstones of the academic arthroplasty, with emphasis on a wide range of experience at NYU Langone Health. The department approaches and techniques, including minimally boasts a center dedicated exclusively to orthopedic EDUCATIONAL FACILITIES invasive surgery and computer-assisted surgical basic science and clinical research. The world- AND TRAINING CENTERS navigation. The fellow is involved in all facets of class research facilities and labs that comprise the patient care, including coverage and resident Musculoskeletal Research Center (MRC) are a vital The New York Simulation Center education in addition to intensive operating room Pablo Castañeda, MD – Co-director resource for all orthopedic residents and fellows. The New York Simulation Center for the Health experience. The fellows work at LOH, Tisch, St Cordelia Carter, MD – Co-Director Sciences, created through a partnership between Francis Hospital and BHC. The Division of Pediatric Orthopedic Surgery actively Molecular and biomechanical research is the The City University of New York and NYU Langone involves the fellow in the daily activities of the major focus of the MRC’s research laboratories. Health, is one of the nation’s largest urban health Division of Shoulder and Elbow Surgery service, including patient care in the clinic, inpatient MRC laboratories provide facilities where faculty, science simulation training facilities. This state-of- (one position) wards, the operating rooms and resident education. residents, fellows, medical students, graduate and the-art, 25,000-square foot center, is located within Fractures, congenital disorders and the entire undergraduate students, and visiting scholars can Bellevue Hospital. The facility’s primary mission is spectrum of pediatric orthopedic and neuromuscular conduct interdisciplinary research in tissue and training students from the affiliated , medical, diseases provide a diverse experience for the fellow and result in an extremely well-rounded program. The treatment of pediatric spinal disorders is a combined effort with the Spine Division. The fellows work at LOH, the Center for Children, The Hassenfeld Children’s Hospital, Tisch and BHC. Andrew Rokito, MD – Co-Director Young Kwon, MD, PhD – Co-Director Visiting International (VIP) Program The Division of Shoulder and Elbow Surgery offers The Department of Orthopedic Surgery a one-year clinical fellowship, accredited by the established a Visiting International Physician (VIP) American Shoulder and Elbow Surgeons (ASES), Program in order to accommodate the numerous which provides trainees a high-volume clinical qualified foreign orthopedic surgeons interested experience and diverse surgical opportunities. The in the cutting edge orthopedic care and research primary goal of the fellowship is to train fellows to practiced by our world-class faculty. provide state-of-the-art treatment for all injuries and conditions affecting the shoulder and elbow and to The visits from international academic observers become proficient in the entire gamut of arthroscopic have a twofold benefit: VIPs learn state-of-the- and open surgical techniques. Fellows also participate art orthopedic techniques available at NYU in our robust orthopedic education program, Langone Health while sharing their own accrued including resident and fellow didactic conferences, knowledge and expertise with our faculty. In order journal clubs, indications conferences, morbidity to participate in the VIP program, a physician must DC 9/14/2020 dental and allied health schools of NYU and CUNY as SPECIAL EDUCATION PROGRAMS OUR COMMUNITY WELLNESS AND RESILIENCE well as residents, practicing physicians and nurses at NYU Langone Health. Training of first responders to International Medical Experience The residents, fellows, medical students, and VIPs Being a resident or fellow at a major teaching disasters in New York City is also a part of the mission Through a relationship developed with Orthopedic participating in the educational programs at NYU hospital is a rewarding but demanding experience. of the center. The department utilizes these facilities Relief Services International (ORSI), the department Langone can take advantage of the diverse and You work long hours and may face emotional, for team training, surgical skills training and objective currently funds and staffs 4 missions to Haiti each vibrant community outside of our hospital walls. physical, and intellectual challenges on a daily structured clinical encounters (OSCE’s). year. An attending orthopedic surgeon, a resident basis. In order to provide patients with the best care surgeon, a scrub nurse/ tech and an anesthesiologist Most of the facilities at which residents and fellows possible, you also need to take care of yourself. Orthopedic Surgical Skills Labs staff the missions. These experiences allow the trainee train (the LOH, LOC, VA, Tisch and BHC) are located An important component of our program is the to provide vital medical services to the underserved within a 17-block in the Gramercy and Kips The NYU Langone Department of Orthopedic development of psychomotor surgical skills at our population of Haiti. In addition to providing needed Bay neighborhoods of Manhattan. Our location in the Surgery is committed to providing resources to state-of-the-art surgical skills labs. A group instruction orthopedic care to often neglected patients, our heart of one of the world’s most exciting and cultural- help our residents and fellows manage the daily wet skills lab is located at Bellevue Hospital. Here residents are involved in helping to re-establish the ly-rich metropolitan areas provides yet another facet demands of being a physician-in-training. Our resi- the department runs bimonthly bioskills surgical only orthopedic training program in the country which to the educational experience at our institution. dents participate in the House Staff Wellness Com- sessions, focusing on various aspects of surgical is headquartered in Port Au Prince. Over the years, mittee. Members of this committee seek to identify care. Sessions include spine surgery exposures and the department has developed mutually beneficial The Housing Services Office at the NYU Grossman and address issues related to the well-being and pedicle screw placement, shoulder arthroplasty, relationships in Haiti. Our residents provide didactic School of Medicine recognizes the challenges mental health needs of residents and fellows at lower extremity trauma and soft tissue hand surgery. conferences and teaching in the operating rooms involved in the search for affordable housing in and NYU Grossman School of Medicine. In addition, the skills lab houses our arthroscopic for the local orthopedic trainees. Candidates are around New York City and acts as a housing resource surgery simulator and training microscope used for selected based on interest and seniority. for faculty, students, and staff at the medical center. Orthopedic surgery house staff are well supported instruction in . as soon as they arrive at NYU Langone for training. Health Policy Certificate This lab also allows for recording video and still The department has created an opportunity for one images while performing surgical procedures and resident every other year beginning in either their can accommodate arthroscopic procedures of the PGY-1 or PGY-2 year, to receive four years of enhanced shoulder, elbow, hip, knee, or ankle. Several types of education about health policy through a Strategy and open procedures can also be performed. The lab has Policy Orthopedic Resident Track (SPORT). There are been used to conduct research studies, anatomy two active SPORT residents in the residency program dissections, and surgical teaching sessions for open at any given time. The SPORT program involves and arthroscopic techniques. Live demonstrations partnerships with three entities: with two-way audio are telecast into the Loeb 1. NYU Wagner Graduate School – Health Policy Auditorium, the principal lecture hall at LOH, as well Advanced Professional Certificate Program, as other conference rooms throughout the hospital, “Health Policy for Clinicians”; to help enhance academic conferences and other 2. The New York State Society of Orthopedic Sur- educational sessions. geons (NYSSOS); 3. The American Academy of Orthopedic Sur- The Herman Robbins MD Memorial Library geons/American Association of Orthopedic The Herman Robbins Medical Library at the Surgeons (AAOS) NYU Langone Orthopedic Hospital is one of Selection for the SPORT program is based on the Health Sciences Libraries at NYU Langone trainee interest and qualifications. Interested Health. In 1993, the library was named after Dr. residents would apply on or before February 1st Herman Robbins, Chairman of the Department of of their PGY-1 year via an application, personal Orthopedic Surgery (1972-1981) for his invaluable statement and letters of support. Decision for and indefatigable service to the orthopedic selection will be communicated by May 1st of their hospital’s residents, patients and staff. Open 24 PGY-1 year. Alternatively, a statement of interest hours a day, it provides a multitude of resources for and application may also be submitted during all orthopedic trainees including bound journals, residency interviews to allow a selected applicant textbooks, search services and conference rooms. to begin the program in their PGY-1 year. DC 9/14/2020 We recognize that residency can be stressful for A COMMITMENT TO DIVERSITY some trainees. Therefore, each resident is assigned a faculty advisor to assist with academic and The Office of Diversity Affairs at NYU Grossman personal challenges, and adjustment to residency. School of Medicine is committed to developing and Department leaders are attuned to individual resi- managing recruitment, retention, and the inclusion dent needs and provide mentorship and support to of trainees. The outreach programs ensure that ensure success during training. students, residents, fellows, and faculty reflect the community it serves. We encourage our trainees to maintain a work-life balance that promotes resilience. As such, we actively The Department of Orthopedic Surgery is com- support activities outside the hospital, including mitted to supporting the goals of the American department sponsored basketball teams, a soc- Academy of Orthopaedic Surgeons in fostering cer team, day ski trips, a yearly golf outing, and a diversity in orthopedic academic programs. As trainee and faculty paint ball day. There is a gym for part of these efforts, our academic staff strives to trainee use in the hospital. These activities serve as identify and train qualified women and underrep- a welcome source of physical activity as well as creat- resented minorities that are interested in the field ing a sense of comradery within the department, both of orthopedic surgery. The department has its own well known-methods to prevent burn out. diversity committee and also funds activities of the Student National Medical Association. The de- partment hosts one of the largest Perry Initiatives yearly to introduce female students to orthopedics and engineering.

DC 9/14/2020 HOW TO APPLY

Residency The deadline for applications for the residency pro- gram is November 1st of the previous academic year. Interviews are offered to approximately 72 applicants.

Applications for entry at the R-1 level will be processed through the American Association of Medical Colleges (AAMC) Electronic Residency Application Systems (ERAS). For application materials and detailed in- structions for the ERAS program, please contact the Dean’s Office at your .

Residency For application to one of our residency programs please contact: Randie Godette, MS Senior Residency Program Coordinator 212-598-6509 [email protected]

Fellowship For application to one of our fellowship programs please contact: Jewel Winters Fellowship Coordinator 212-598-6509 [email protected]

For application to our primary care sports medicine fellowship program please contact: Meena Casas Program Manager [email protected].

VIP Academic Observership For an application to the VIP program please contact: Sandra Martinez VIP Program Coordinator 212-263-7198 [email protected]

For more information about our Educational Programs visit us on the web at: https://med.nyu.edu/ortho

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