Healthcare Provider Details

I. General information

NPI: 1649225897
Provider Name (Legal Business Name): CONIFER PARK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FRANKLIN ST
SCHENECTADY NY
12305-2100
US

IV. Provider business mailing address

PO BOX 10092
ALBANY NY
12201-5092
US

V. Phone/Fax

Practice location:
  • Phone: 518-372-7031
  • Fax: 518-372-7064
Mailing address:
  • Phone: 589-528-4085
  • Fax: 518-399-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY SMITH
Title or Position: DIRECTOR, OP BILLING DEPT
Credential:
Phone: 518-952-8408