CONIFER PARK, INC (NPI# 1538180351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538180351 |
| Entity Type | Organization |
| Organization Name | CONIFER PARK, INC |
| Practice Address |
79 Glenridge Rd Glenville NY 12302-4523 |
| Mailing Address |
Po Box 417153 Boston MA 02241-7153 |
| Practice Telephone | 5189528142 |
| Mailing Telephone | 5189528142 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-03-20 |
| Authorized Official Name | ANDREA M BETTS (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 5189528142 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 00000 | NY | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01420800 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | CONIFER PARK, INC. | 79 Glenridge Road, Glenridge, Ny 12302 |
| Street Address |
79 GLENRIDGE RD |
| City | GLENVILLE |
| State | NY |
| Zip Code | 12302-4523 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083645535 | Christopher J Rizzo | Internal Medicine | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2006-07-05 |
| 1538726229 | Samuel John Halajian | Physician Assistant | 79 Glenridge Rd, Glenville, NY 12302-4528 | 2019-05-29 |
| 1801235155 | Elizabeth Magliocca | Registered Nurse | 79 Glenridge Rd, Cottage #1, Glenville, NY 12302-4523 | 2013-06-20 |
| 1093158453 | Kristen Rizzuto | Counselor | 79 Glenridge Rd, Cottage #1, Glenville, NY 12302-4523 | 2013-04-16 |
| 1043515380 | Nicole Lifite | Registered Nurse | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2011-01-18 |
| 1073829578 | Patricia Anne Pulver | Physician Assistant | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2010-08-23 |
| 1588843569 | Mirabelle Beck | Nurse Practitioner | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2007-10-26 |
| 1336339969 | Conifer Park, Inc. | Clinic/Center | 79 Glenridge Rd, Cottage #1, Glenville, NY 12302-4523 | 2007-07-30 |
| 1336344258 | Matthew Levine | Physician Assistant | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2007-06-20 |
| 1740364215 | Timothy Donnelly | Physician Assistant | 79 Glenridge Rd, Glenville, NY 12302-4523 | 2006-10-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053921973 | Maria Magnoua Castaneda | Case Manager/Care Coordinator | 701 Carnbridge Manor Dr., Scotia, NY 12302 | 2020-08-05 |
| 1184050353 | Empire Vision Centers, Inc | Eyewear Supplier (Equipment, not the service) | 10 Glenridge Rd Store#1, Glenville, NY 12302 | 2013-09-19 |
| 1265773212 | Caroline M Lupi | Licensed Practical Nurse | 19 Glenridge Rd Ste E, Glenville, NY 12302 | 2013-03-14 |
| 1477805844 | Kinum Chiropractic PC | Chiropractor | 201glen Ave., Scotia, NY 12302 | 2012-10-10 |
| 1558686444 | Marsha M Tulloch | Licensed Practical Nurse | 125 Mohawk Ave, Gentle Home Health Care, Scotia, NY 12302 | 2010-04-02 |
| 1841515988 | Maureen K. Hansen | Licensed Practical Nurse | 109 Mohawk Ave., Gentle Home Health Care, Inc., Scotia, NY 12302 | 2010-04-01 |
| 1275858425 | Flora Lynn Worden | Licensed Practical Nurse | 109 Mohawk Ave, Scotia, NY 12302 | 2010-03-31 |
| 1255654943 | Kevin Daniel Valade | Pharmacist | 257 Saratoga Rd., Glenville, NY 12302 | 2010-03-09 |
| 1356574149 | Ann Elizabeth Helbling | Community Health Worker | 419 Weatherwax Road, Glenville, NY 12302 | 2009-08-27 |
| 1689811317 | Roger Guy Singer | Chiropractor | 353 Saratoga Road, Scotia, NY 12302 | 2009-01-16 |
| Find all providers in zip 12302 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992337224 | Council On Addiction Recovery Services, Inc. | Substance Abuse Rehabilitation Facility | 1355 Olean-portville Road, Westons Mills, NY 14788-1476 | 2020-02-05 |
| 1528609799 | Ebdk At Calverton | Substance Abuse Rehabilitation Facility | 525 Jan Way, Calverton, NY 11933-3005 | 2019-09-30 |
| 1124679998 | Resource Recovery Center of Orange County LLC | Substance Abuse Rehabilitation Facility | 68 Crystal Run Rd, Middletown, NY 10941-7100 | 2019-09-24 |
| 1326506064 | Mountainside - Huntington | Substance Abuse Rehabilitation Facility | 141 E Main St Ste 2, Huntington, NY 11743-2850 | 2019-03-12 |
| 1023589090 | Argus Community, Inc. | Substance Abuse Rehabilitation Facility | 2015-25 Madison Avenue, 4th Floor, New York, NY 10035-1015 | 2018-12-16 |
| 1578030797 | Hope House, Inc. | Substance Abuse Rehabilitation Facility | 577 Livingston Ave, Albany, NY 12206-2408 | 2018-10-25 |
| 1467949867 | Ocean Recovery East LLC | Substance Abuse Rehabilitation Facility | 113 E 60th St, New York, NY 10022-1939 | 2018-04-20 |
| 1578050944 | Elev8 Center New York, LLC | Substance Abuse Rehabilitation Facility | 151 W 136th St, New York, NY 10030-2606 | 2018-04-20 |
| 1518491174 | Aaron Smith | Substance Abuse Rehabilitation Facility | 460 Brielle Ave, Building H, Staten Island, NY 10314 | 2017-04-20 |
| 1346772019 | Catholic Charities of The Diocese of Rockville Centre | Substance Abuse Rehabilitation Facility | 30 Carlough Rd Ste C, Bohemia, NY 11716-2919 | 2017-03-31 |
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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.