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Get NY EMEDNY-436901 2019

Official directives of the Department, including, but not limited to Part 504 of 18 NYCRR which can be found at the Department of Health s website, www.health.ny.gov. This enrollment form should be used by practitioners seeking enrollment as: 1. An ordering referring, attending or prescribing practitioner (attending providers should use this form if their name and NPI will only appear on the hospital s claim). These providers will not submit claims to Medicaid and, therefore will not receiv.

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