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Providers > Provider Forms

Presently, there is a freeze on all new provider contracting with Atlantis Health Plan. Please check this site again for future updates.

If you would like to update your demographic information in our claim system or our provider directory,

  1. Complete a Provider Profile Update form.
  2. Complete a W-9 form.

Please send the above documents to:

Atlantis Health Plan
Attn: Credentialing
45 Broadway, Suite 300
New York, NY 10006
Fax: 646-929-9216

Provider Profile Update W9