If the LPN/RN is currently actively enrolled in NY Medicaid, the completed and signed Private Duty Nursing Program For Medically Fragile Children form can be submitted to the fax or email indicated below, or via US mail to eMedNY, Box 4610, Rensselaer, NY 12144-4610.
If the LPN/RN is NOT actively enrolled in NY Medicaid, she/he must first enroll in NY Medicaid.
If the LPN/RN is enrolling in NY Medicaid under the full, regular enrollment, a completed and signed NY Medicaid enrollment application MUST be mailed along with the Private Duty Nursing Program For Medically Fragile Children form, via US Mail to eMedNY, Box 4603, Rensselaer, NY 12144-4603.
Fax: (518) 473-7251 - Include a fax cover sheet with the subject "Medically Fragile and/or PDN Directory Update Needed." Be sure to include a contact name, telephone number and email address so you can be reached if additional information is needed.
Email: providerenrollment@health.ny.gov - Include "Medically Fragile and/or PDN Directory Update Needed" in the subject line. Be sure to include a contact name, telephone number and email address so that you can be reached if additional information is needed.