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SEAL NOTARY PUBLIC. EMEDNY-490602 8/14 A Certification Statement must be completed and submitted with your enrollment application After your enrollment in the NY Medicaid Program is approved you will receive written notification of your assigned Electronic Transmitter Identification Number ETIN. The ETIN will be needed to submit transactions to NY Medicaid. If your transactions will be submitted under a different existing ETIN after you are notified of your approved enrollment you will need...
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