Provider Application

If you are a Primary Care Provider, please be sure to review the Primary Care Provider Criteria before completing the Application.

Provider Application

Please remember to sign the Application and the Consent for Release of Information and return them with the attachments to the Amida Care Offices:

Amida Care, Inc.
248 W. 35th Street, 7th Flr
New York, NY 10001

NOTE: PLEASE SUBMIT ALL DOCUMENTS AND ANSWER ALL QUESTIONS

Please call the Provider Services Department at 1-800-556-0674 if you have any questions.