Healthcare Provider Details

I. General information

NPI: 1881517308
Provider Name (Legal Business Name): BETHANY DOOLITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEX DOOLITTLE

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 BROADWAY STE 201
KINGSTON NY
12401-5160
US

IV. Provider business mailing address

1 ELY PARK BLVD
BINGHAMTON NY
13905-1480
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-2266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: