Provider Recruitment

Provider Recruitment Form

The CareConnect provider network includes some of the best clinicians throughout the lower eight counties of New York State: Bronx, Brooklyn, Nassau, New York, Queens, Richmond, Suffolk, Westchester. If you’re interested in becoming a CareConnect provider, please fill out the form below.^† Our dedicated Credentialing team will review your request and follow-up based on network adequacy.

†CareConnect requires all applicable practitioners who apply for participation to be board certified or in the process of receiving certification after completing requisite board education and training within a time frame set by the applicable specialty. Primary care and specialty physicians must be board certified in their area of practice.

* Indicates required field

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HOSPITAL AFFILIATION

Please indicate your hospital affiliation. * Select all that apply.

Bellevue Hospital Center Bridgeport Hospital Coney Island Hospital Elmhurst Hospital Glen Cove Hospital Greenwich Hospital Harlem Hospital Center Huntington Hospital Jacobi Medical Center Kings County Hospital Lenox Hill Hospital Lincoln Medical & Mental Health Center Long Island Jewish Forest Hills Long Island Jewish Medical Center Long Island Jewish Valley Stream Maimonides Medical Center Manhattan Eye & Ear Hospital (MEETH) Metropolitan Hospital Center Montefiore Medical Center - Montefiore Hospital Montefiore Medical Center - Montefiore Westchester Square Montefiore Medical Center - Wakefield Hospital Montefiore Medical Center - Weiler Hospital

Montefiore Mt. Vernon Hospital Montefiore New Rochelle Hospital Nassau University Medical Center North Central Bronx Hospital North Shore University Hospital Northern Westchester Hospital Peconic Bay Medical Center Phelps Hospital Plainview Hospital Queens Hospital Center South Oaks Hospital Southside Hospital Staten Island University Hospital (North) Staten Island University Hospital (South) Steven & Alexandra Cohen Children’s Medical Center Syosset Hospital White Plains Hospital Woodhull Medical & Mental Health Center Wyckoff Heights Medical Center Yale-New Haven Hospital Zucker Hillside Hospital No hospital affiliation

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YOUR PRACTICE

Select the county (or counties) in which you practice. * Select all that apply.

Bronx Brooklyn Nassau New York Queens Richmond Suffolk Westchester

Select your specialty. * Select... Allergy and Immunology Cardiology Dermatology Emergency Medicine Endocrinology Family Medicine Internal Medicine Medical Genetics and Genomics Neurological Surgery Neurology Nuclear Medicine Nurse Practitioner Obstetrics and Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Radiology Surgery Thoracic Surgery Urology Select... Acupuncture Applied Behavioral Analysis Audiology Certified Drug & Alcohol Counselor Chiropractic Medicine Clinical Psychology Counselor Dentistry Nutritionist Occupational Therapy Optometry Physical Therapy Physician Assistant Social Worker Speech Therapy

Select your sub-specialty (if any)

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CONTACT INFORMATION

Our network is currently closed for your specialty. We evaluate network adequacy every six months. You can fill out the information below, and our Credentialing team will contact you should an opening for your specialty occur.

Provider’s Full Name *

Phone Number *

Email Address *

ZIP Code *

Submission of a Provider Recruitment form is the first step to becoming a part of the CareConnect Network. This submission can lead to a Credentialing application and does not guarantee enrollment in the plan. All submissions will be reviewed based on current network need and you should expect a response within 60 days.

I acknowledge that submission of a Provider Recruitment form does not guarantee enrollment *

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