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NPI Code Detail

MEDICARE: CONIFER PARK, INC.

MEDICARE: CONIFER PARK, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235185612
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONIFER PARK, INC.
Provider Business Mailing Address
First Line : PO BOX 10092
Second Line :
City : ALBANY
State : NY
Zip : 12201-5092
Country : US
Telephone Number : 518-952-8408
Fax Number : 518-399-6860
Provider Business Practice Location Address
First Line : 556 CLINTON AVE S
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-1105
Country : US
Telephone Number : 585-442-8422
Fax Number :
Authorized Official
Title or Position : DIRECTOR, OP BILLING DEPT
Name : MS. TAMMY SMITH
Credential :
Telephone Number : 518-952-8408
Provider Enumeration Date : 05/26/2006
Last Update Date : 04/29/2021

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