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New York State Department of Health / NY State of Health fax number

(855) 900-5557

NY State of Health Appeals Unit

Used for: Submitting NY State of Health forms and supporting documents by fax to the NY State of Health Appeals Unit (e.g., DOH-5231 Appeal Request Instructions and DOH-5087 Authorized Representative Identity Verification).

Fax destination details

Department
NY State of Health Appeals Unit
Purpose
Submitting NY State of Health forms and supporting documents by fax to the NY State of Health Appeals Unit (e.g., DOH-5231 Appeal Request Instructions and DOH-5087 Authorized Representative Identity Verification).
Form
DOH-5231; DOH-5087 — NY State of Health Appeal Request – Instructions (DOH-5231); Verifying an Authorized Representative’s Identity (DOH-5087)
Address
NY State of Health Appeals Unit, P.O. Box 11729, Albany, NY 12211
Voice phone
1-855-355-5777

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DOH-5231: Submit an appeal request within 60 days; you may upload the form on the NY State of Health website, fax the form to 1-855-900-5557, or mail to NY State of Health Appeals Unit, P.O. Box 11729, Albany, NY 12211. DOH-5087: Authorized Representative Identity Verification; submit the form with copies of identity documents and mail to NY State of Health or fax to 1-855-900-5557.

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