Completing a Fillable PDF form

Follow the steps below to complete your PDF online:

  1. Download and install Adobe Acrobat Reader
  2. Go back to the forms page and download the PDF you need to fill-out
  3. Open the downloaded PDF in Adobe Acrobat Reader
  4. Complete the form
  5. Click on File > Save As PDF


For applicants in New York City’s 5 boroughs, Nassau and Suffolk counties, as well as New Jersey and Connecticut, please send your completed application and agreement(s) to:


For applicants from all other counties in New York State and other states, please send your completed application and agreement(s) to:


Please note: The email addresses above are for the submission of new applications only. Our Credentialing team will reach out to you if additional information is needed. We recommend waiting at least 45 days before checking on the status of your application. To check status, call our Provider Services Line at 877-833-2729. If you have an account for our secure provider portal, you can check your practice profile to see if your participation has changed.