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General NPI Number Information
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NPI Number | 1336339969
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Entity Type | Organization
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Legal Business Name | CONIFER PARK, INC.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 79 GLENRIDGE RD COTTAGE #1
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City | GLENVILLE
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State | NY
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Zip | 12302-4523
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Country | US
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Telephone | 518-952-8121
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Fax | 518-952-8287
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Provider Business Mailing Address
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Address Line | PO BOX 10092
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City | ALBANY
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State | NY
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Zip | 12201-5092
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Country | US
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Telephone | 518-952-8408
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Fax | 518-399-6860
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Authorized Official
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Title or Position | OP BUSINESS MANAGER
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Name | TAMMY SMITH
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Credential |
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Telephone | 518-952-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 081110730
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License Number State | NY
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