Get the free PROVIDER ENROLLMENT INFORMATION UPDATE FORM 1 14 2013 - home nyc
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Vaccines for Children Program Bureau of Immunization New York City Department of Health and Mental Hygiene 42-09 28th Street, 5th Floor, CN-21 Queens, New York, 11101-4132 Phone: (347) 396-2404 /
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How to fill out provider enrollment information update
How to fill out provider enrollment information update:
01
Visit the website of the provider enrollment organization or agency.
02
Locate the section for provider enrollment forms or information updates.
03
Download the provider enrollment information update form.
04
Fill out the form with accurate and up-to-date information.
05
Double-check the form for any errors or missing information.
06
Attach any required supporting documents, such as updated licenses or certifications.
07
Submit the completed form and supporting documents according to the instructions provided.
08
Keep a copy of the submitted form and supporting documents for your records.
Who needs provider enrollment information update:
01
Healthcare providers who have changed their contact information, such as address or phone number.
02
Healthcare providers who have acquired new licenses or certifications.
03
Healthcare providers whose business or practice information has changed, such as ownership or name.
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What is provider enrollment information update?
Provider enrollment information update is the process of updating the information of a healthcare provider in the provider enrollment system.
Who is required to file provider enrollment information update?
Healthcare providers who are enrolled in the provider enrollment system are required to regularly update their information.
How to fill out provider enrollment information update?
Providers can fill out the enrollment information update form online or through the designated enrollment portal.
What is the purpose of provider enrollment information update?
The purpose of provider enrollment information update is to ensure accurate and up-to-date information of healthcare providers in the system.
What information must be reported on provider enrollment information update?
Providers must report any changes in address, contact information, credentials, licensing, and any other relevant information.
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