` Change Email Address for Attestation
NY Medicaid  
home | self help | glossary | site map

Wage Parity > Change Email for Wage Parity Attestation

Email Change Request for Wage Parity Attestation

Please fill out the form below to change your email address on file for the Wage Parity Attestation Form.


Name:
Email:
Phone Number:
NPI:    (If exempt, enter "EXEMPT" in field)
MMIS ID
(only if NPI exempt)


ReCaptcha: