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license #: leave blank ny medicaid id: complete if either the revalidation, change of ownership, reinstatement/reactivation or receivership box was checked. ny medicaid id is -digits dba: optional control of facility code: click here for the list of codes dea or nys cont subs lic # & dates: these fields...
license #: leave blank ny medicaid id: complete if either the revalidation, change of ownership, reinstatement/reactivation or receivership box was checked. ny medicaid id is -digits dba: optional control of facility code: click here for the list of codes dea or nys cont subs lic # & dates: these fields...
license #: leave blank ny medicaid id: complete if either the revalidation, change of ownership, reinstatement/reactivation or receivership box was checked. ny medicaid id is -digits dba: optional control of facility code: click here for the list of codes dea or nys cont subs lic # & dates: these fields...
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