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Provider Relations Help

Please submit the form below to contact Provider Relations for assistance or for information about joining the Care Design NY provider network.

Please fill out the form to the best of your ability with as much information as possible. Not all fields may apply to your request.


CDNY Provider Ticket Submission Form
Provider Name  
First Name  
Last Name  
Email  
Phone  
Subject  
Agency / Provider Type   
If Provider Type is Other, Please Indicate Below  
Counties   
Category   
Description   
Priority   
Attachment   Attach files
Each of your file(s) can be up to 20MB in size.
   
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