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CONIFER PARK, INC.
NPI 1336339969
Clinic/Center - Rehabilitation, Substance Use Disorder in Glenville, NY

Active since July 30, 2007CLIA 33D0914711 · Waiver
79 GLENRIDGE RD, COTTAGE #1, GLENVILLE, NY 12302(518) 952-8121(518) 952-8287 Get Directions Write a Review

NPPES record last updated: December 23, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 23, 2021, Apr 29, 2021 (2 updates tracked since 2021).

About Conifer Park, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONIFER PARK, INC. (NPI 1336339969) is a healthcare organization registered as a rehabilitation, substance use disorder in Glenville, New York and active in the NPI registry since July 2007. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Tammy Smith, Op Business Manager, as its authorized official.

NPPES Registry Identity

NPI1336339969
Entity TypeOrganization
Primary Taxonomy261QR0405X
Legal Business NameCONIFER PARK, INC.
Location Address79 GLENRIDGE RD, COTTAGE #1Glenville, NY 12302-4523
Mailing AddressPo Box 10092Albany, NY 12201-5092 · (518) 952-8408 · Fax (518) 399-6860
Phone(518) 952-8121
Fax(518) 952-8287
Organization SubpartNo
Authorized OfficialTammy SmithOp Business Manager · (518) 952-8408
Enumeration DateJuly 30, 2007
Last NPPES UpdateDecember 23, 20212 updates tracked since enumeration
NPPES CertifiedDecember 23, 2021
✔ NPI 1336339969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities
Taxonomy Code261QR0405X
License✔ Licensed in NY · 081110730
79 GLENRIDGE RD, Glenville, NY 12302
Open in Google Maps ↗

Other Identifiers 1

Medicaid01420800NY

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0914711

Conifer Park Inc · Glenville, NY
Active · expires Mar 26, 2027
CLIA Number33D0914711
Laboratory TypeOther
Certificate Effective DateMay 8, 1996
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Richard E. Gold
Laboratory Phone(518) 399-6446
Laboratory LocationConifer Park Inc79 Glenridge Road, Glenville, NY 12302
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTOPHER J RIZZO M.D.
Internal Medicine (Addiction Medicine)
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142
KRISTEN RIZZUTO LMSW
Counselor (Addiction (Substance Use Disorder))
79 GLENRIDGE RD, COTTAGE #1
GLENVILLE, NY 12302
Schenectady County (518) 952-8140
THOMAS C DOWLING
Nurse Practitioner (Psychiatric/Mental Health)
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142
LATCHMI CIPRIANA RN
Registered Nurse
79 GLENRIDGE RD, COTTAGE #1
GLENVILLE, NY 12302
Schenectady County (518) 952-8121
CARLY GALLAGHER LMSW
Social Worker
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 399-6446
MR. ROBERTO C DIMAMBRO CASAC
Counselor (Addiction (Substance Use Disorder))
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8408
DANESH IRANI
Physician Assistant
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (518) 952-8142
JOSEPHINA PIMENTEL
Nurse Practitioner (Family)
79 GLENRIDGE RD
GLENVILLE, NY 12302
Schenectady County (838) 251-1633

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Conifer Park, Inc.'s NPI number?

The NPI number for Conifer Park, Inc. is 1336339969. It was assigned to this organization in the NPPES registry on July 30, 2007.

Where is Conifer Park, Inc. located?

Conifer Park, Inc. is located at 79 Glenridge Rd Cottage #1, Glenville, NY 12302. The listed phone number is (518) 952-8121.

What is Conifer Park, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

Does Conifer Park, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0914711) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Conifer Park, Inc. was last updated on December 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.