Healthcare Provider Details

I. General information

NPI: 1407809957
Provider Name (Legal Business Name): B BERENICE DOOLEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LEGION DR
COBLESKILL NY
12043-5111
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 518-254-2555
  • Fax: 518-234-3415
Mailing address:
  • Phone: 607-547-3909
  • Fax: 607-547-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: