Get Emedny Change Of Address Form
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How to fill out the Emedny Change Of Address Form online
The Emedny Change Of Address Form is a vital document for health care providers in New York State to update their correspondence, pay-to, and corporate addresses with the Medicaid Program. This guide provides clear, step-by-step instructions on how to complete this form efficiently and accurately using online resources.
Follow the steps to complete the Emedny Change Of Address Form online.
- Press the ‘Get Form’ button to access the form and open it in your preferred editor.
- Fill in your National Provider Identifier (NPI) number, if applicable, in the designated field.
- If you are exempt from having an NPI, enter your provider number in the appropriate section.
- Provide your exact Provider name as it is enrolled with the Medicaid program in the designated field.
- Indicate your new correspondence address. Under Locator Code 01, you must specify a street address; use caution as a P.O. Box alone is not acceptable. Fill in the attention line if necessary.
- Complete the street, city, state, zip code, and county sections for the correspondence address.
- Enter your contact information, including telephone number and email address, ensuring all details are accurate.
- Next, indicate the new pay-to address under Locator Code 02. Similar to the correspondence address, specify all required details, including any attention necessary.
- Complete the corporate address section, ensuring that it matches the name and address as on the FEIN documentation. Remember to provide an attention line if needed.
- Sign the form in the designated area, ensuring the signature is original and legible. Include the printed name and title of the authorized representative as well as the date.
- After filling out the form, you can save the completed document, download it, print it, or share it as needed.
Complete your Emedny Change Of Address Form online today to ensure your provider information is up to date.
Changing your address online is often more convenient and quicker than doing so in person. Online forms, like the eMedny Change Of Address Form, allow you to submit changes anytime, eliminating the need to travel. However, some individuals may prefer in-person visits for additional support or specific inquiries. Ultimately, the best option depends on your comfort level and preferences.
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