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General NPI Number Information
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NPI Number | 1356396543
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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 | 05/24/2006
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 2435 6TH AVE
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City | TROY
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State | NY
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Zip | 12180-2227
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Country | US
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Telephone | 518-274-5143
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Fax | 518-273-1350
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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 | DIRECTOR, OB BILLING DEPT.
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Name | MS. 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 |
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License Number State |
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