Organization
CONIFER PARK, INC.
Active
Organization
CONIFER PARK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA A PETTEYS (DIRECTOR OP BILLING)
(518) 952-8140
Entity
Organization
Contact information
Practice address
323 LAKE HILL ROAD, HAWLEY COTTAGE, 1ST FLOOR, BURNT HILLS, NY 12027-9772
(518) 399-8182
(518) 372-7064
Mailing address
PO BOX 10092, ALBANY, NY 12201-5092
(518) 985-8408
(518) 399-6860
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
081110730
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420800
—
NY
Enumeration date
07/27/2007
Last updated
04/29/2021
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