Join Our Network

Thank you for your interest in participating with Ambetter from WellCare of New Jersey! If you would like to receive more information on becoming a provider within our network, please complete the form below.

Required fields are marked with an asterisk (*)

Provider First Name *

Provider Last Name *

Degree Type

Provider to existing agreement Check to add provider to existing agreement

Join as a group Check to join as a group

Service more than one state Check if you service more than one state

If you service more than one state, please list your states:

Group Name

Tax Identification Number *

Specialty *

Please explain if you picked "Not Applicable" as your "Specialty" *

Mailing Address Line 1 *

Mailing Address Line 2

City *

State *

Zip Code *

County *

Facility (type)

NPI *

CAQH Number

Medicare Number

Medicaid Number

License Number

Primary Contact Name *

Email *

Please provide any additional information

Agreement * I understand that this inquiry does not guarantee my participation in the Ambetter network.

Agreement * I understand that failure to complete this inquiry accurately and completely will result in the delay of evaluating my request.

Become An Ambetter Provider in New Jersey | Ambetter from WellCare of New Jersey

Join Our Network