WebPhysician 0460 1. Copy of your DEA Certificate . 2. Specialty Form EMEDNY-490301, if applicable . Physician Assistant (Registered) 0462 1. Form EMEDNY-412601 . Supervising Physician Certification . 2. Copy of DEA Cert. if prescribing Webcertification statement instructions A Certification Statement must be completed and submitted with your enrollment application: After your …
Provider Enrollment - eMedNY
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Compliance Certification Office of the Medicaid Inspector General
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