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Atlantis Health Plan (TM)
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To request a new pcp, please use the PCP Request Form.

More ways to contact us:

    by phone or fax

212-747-0877
866-747-8422 (toll free)
212-747-0843 (fax)

    by mail

Atlantis Health Plan, Inc.
39 Broadway
Suite 1240
New York, NY 10006

health advocate (TM)
Contact Us > Primary Care Physician Request/Change Primary Care Physician Request

If you or a family member would like to change your current Primary Care Physician, or if you have not selected a Primary Care Physician yet and wish do so, please fill out this form.

* - denotes a required field
Primary Care Physician Request/Change Primary Care Physician Request
Member Name *

Member ID *

Group Number

Previous Primary Care Physician
Name

Provider ID

Address

New Primary Care Physician
Name *

Provider ID *

Address

Address 2

City

State

Zipcode

Please be sure to verify with AHP Member Services 1(866) 747-8422 or the Provider Directory that the new chosen Primary Care Physician is an Atlantis Health Plan contracted physician.



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