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Provider Request

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Liberty Health Advantage HMO

1 Huntington Quadrangle
Suite 3N01
Melville, NY 11747
Phone: (866) 542-4269
TTY: (800) 662-1220
Office Hours: 8:00 a.m. - 6:00 p.m.

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Contact Information

Member Services

  • 1-866-542-4269
  • 1-800-662-1220 TTY
  • Monday through Sunday
  • 8:00 a.m. to 8:00 p.m.

Enrollment Representative

  • 1-866-542-4269
  • 1-800-662-1220 TTY
  • Monday through Sunday
  • 8:00 a.m. to 8:00 p.m.

Enrollment

Download a 2011 Enrollment Form

Download a 2012 Enrollment Form

You may download, complete, sign and date an enrollment form. Application Instructions

Once you have completed the form please fax it to:

1-631-227-3484

Or mail it to:

Liberty Health Advantage
1 Huntington Quadrangle
Suite 3N01
Melville, NY 11747

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Copyright © 2011. All Rights Reserved.

Liberty Health Advantage HMO is a Coordinated Care Plan with a Medicare Advantage contract and a contract with the New York State Medicaid program.

H3337_LHA_MARK_1227 CMS Approved 11/03/2011

Last Modified: Sun, September 18, 2011 10:44:28