| Organization Name: | CONIFER PARK, INC. |
| NPI Number: | 1336339969 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA A PETTEYS (DIRECTOR OP BILLING) |
| Mailing Address: | 79 Glenridge Rd Cottage #1 Glenville |
| State: | NY US |
| Postal Code: | 123024523 |
| Phone Number: | 5189528121 |
| Fax Number: | 5189528287 |
| NPI Enumeration Date: | 07/30/2007 |
| NPI Last Update Date: | 03/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 081110730 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |