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NYU Langone Health (Tisch Hospital / NYU Langone Orthopedic Hospital) – Financial Counseling Services fax number

(212) 263-8806

Financial Counseling Services

Used for: Submitting the NYU Langone Financial Assistance Application for hospital charges

Fax destination details

Department
Financial Counseling Services
Purpose
Submitting the NYU Langone Financial Assistance Application for hospital charges
Form
New York State Uniform Hospital Financial Assistance Application — New York State Uniform Hospital Financial Assistance Application
Address
560 First Avenue, SK-133, New York, NY 10016
Voice phone
1-866-486-9847

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
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Complete the enclosed Uniform Financial Assistance Application and return within 30 days. This document covers hospital charges only and does not include physician charges. Include required information as directed and sign the form; the hospital will determine eligibility and provide a written determination within 30 days.

Official form instructions are published as a downloadable file on the organization's website.

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