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Get Application For Enrollment As A Specialist - Emedny
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How to fill out the Application For Enrollment As A Specialist - EMedNY online
This guide provides clear and actionable steps for completing the Application for Enrollment as a Specialist - EMedNY online. By following these instructions, users can effectively fill out the necessary information and submit their application with confidence.
Follow the steps to complete your application accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Type or print your information in the spaces provided. Ensure all details are accurate and legible.
- Proceed to Section B, where you will input your education and training details. Include information on your medical/dental degree, internship, residency, and fellowship, specifying the institution’s name, location, and the dates of your training.
- In Section C, detail your hospital appointments from the last five years. List the hospital name, title/specialty, and hours worked per week during your appointment period.
- For Section D, provide details of your U.S. specialty board certification(s), including the name of the board and the certification dates.
- If you are an orthodontist, complete Section E by indicating the percentage of your practice dedicated to orthodontics.
Get started on your application for enrollment online today!
Call the HRA Medicaid Helpline at 1-888-692-6116 for more information or visit a Medicaid Office to apply. During the COVID-19 Emergency, applications may be submitted via fax to 917-639-0732.
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