Please send our office the completed application, along with the W-9, and supplementary documents listed on page 1 of the application.
Once completed, this package can be emailed, faxed, or mailed to our office.
Once completed, this package can be emailed, faxed, or mailed to our office.
Contact
Bronx United IPA
140 Wadsworth Ave., Suite 4
New York, NY 10033
providerrelations@unitedipas.com
Phone: (646) 417-0500
Fax: (212) 320-0597