CONIFER PARK, INC. (NPI# 1366498768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366498768 |
| Entity Type | Organization |
| Organization Name | CONIFER PARK, INC. |
| Practice Address |
526 Old Liverpool Rd Liverpool NY 13088-6238 |
| Mailing Address |
Po Box 10547 Albany NY 12201-5547 |
| Practice Telephone | 3154533911 |
| Practice Fax Number | 3154530197 |
| Mailing Telephone | 5189528408 |
| Mailing Fax Number | 5189528287 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-01-30 |
| Authorized Official Name | MS. TAMMY SMITH (DIRECTOR, OP BILLING DEPT) |
| Authorized Official Telephone | 5189528408 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01420800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730379504 | Conifer Park, Inc. | Clinic/Center | 323 Lake Hill Road, Hawley Cottage, 1st Floor, Burnt Hills, NY 12027-9772 | 2007-07-27 |
| 1346296720 | Conifer Park, Inc. | Clinic/Center | 80 Sharron Ave, Plattsburgh, NY 12901-4700 | 2006-05-26 |
| 1235185612 | Conifer Park, Inc. | Clinic/Center | 556 Clinton Ave S, Rochester, NY 14620-1105 | 2006-05-26 |
| 1972558179 | Conifer Park, Inc. | Clinic/Center | 55 Elm St, Glens Falls, NY 12801-3549 | 2006-05-24 |
| 1356396543 | Conifer Park, Inc. | Clinic/Center | 2435 6th Ave, Troy, NY 12180-2227 | 2006-05-24 |
| 1154652709 | Conifer Park, Inc. | Substance Abuse Rehabilitation Facility | 15 Henning Rd, F. Donald Myers Education Center, Saratoga Springs, NY 12866-3749 | 2010-01-21 |
| 1336339969 | Conifer Park, Inc. | Clinic/Center | 79 Glenridge Rd, Cottage #1, Glenville, NY 12302-4523 | 2007-07-30 |
| 1366632986 | Conifer Park, Inc. | Clinic/Center | 216 Main St, Suite #2, Hudson Falls, NY 12839-1813 | 2007-07-30 |
| 1023208139 | Conifer Park, Inc. | Clinic/Center | 1051 Dix Ave, Buildings E and G, 1st Floors, Hudson Falls, NY 12839-1053 | 2007-07-26 |
| 1649225897 | Conifer Park, Inc. | Clinic/Center | 600 Franklin St, Schenectady, NY 12305-2100 | 2006-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | CONIFER PARK, INC. | 79 Glenridge Road, Glenridge, Ny 12302 |
| Street Address |
526 OLD LIVERPOOL RD |
| City | LIVERPOOL |
| State | NY |
| Zip Code | 13088-6238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801406012 | Shaficia Durham | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2020-08-03 |
| 1235757964 | Ashley Barone | Registered Nurse | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2020-07-09 |
| 1366067225 | Sonya Rettig | Registered Nurse | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2020-06-16 |
| 1447804158 | Daniel M Guglielmo | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2019-07-31 |
| 1306350814 | Jacqueline Socia | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2017-11-20 |
| 1295248797 | Gabrielle Glaski | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2017-11-07 |
| 1427576461 | Katrina Sabanal | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2017-08-30 |
| 1184155111 | David Bataille | Licensed Practical Nurse | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2017-03-22 |
| 1821537416 | Tamzin Bailey | Counselor | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2017-02-16 |
| 1568917151 | Christal Ann Mccullough | Registered Nurse | 526 Old Liverpool Rd, Liverpool, NY 13088-6238 | 2016-08-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878966 | Anthony Edward Blumetti | Psychologist | 5100 W. Taft Road, Suite 3b, Liverpool, NY 13088 | 2019-12-12 |
| 1609350016 | Alice Nellenbach | Physical Therapy Assistant | 346 Electronics Pkwy, Liverpool, NY 13088 | 2018-09-20 |
| 1043741457 | Dawn Marie Thomas | Licensed Practical Nurse | 212 Old Liverpool Road, Building 7 Apartment 6, Liverpool, NY 13088 | 2017-03-27 |
| 1154775633 | Arielle L Leonard | Massage Therapist | 609 7th N. Street, Suite 2, Liverpool, NY 13088 | 2016-04-20 |
| 1942664362 | Accessibility Solutions, Inc. | Contractor | 115 Luther Avenue, Liverpool, NY 13088 | 2016-04-12 |
| 1497176333 | Sergey Golovko | Psychiatry & Neurology | 125 Sun Harbor Dr, Liverpool, NY 13088 | 2013-12-19 |
| 1205275286 | Brandon William Crandall | Nurse Practitioner | 5100 West Taft Rd., Suite 1c, Liverpool, NY 13088 | 2013-06-23 |
| 1184976805 | Audrey Irene Tyszka | Social Worker | 5100 W Taft Rd Ste 1f, Liverpool, NY 13088 | 2012-10-04 |
| 1790049096 | Kelley Beth Burt | Speech-Language Pathologist | 110 Elwood Davis Road, Liverpool, NY 13088 | 2012-07-02 |
| 1811288954 | Nedim Ruhotina | Urology | 100 Metropolitan Park Drive, Suite 100, Liverpool, NY 13088 | 2011-04-24 |
| Find all providers in zip 13088 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.