Provider Demographics
NPI:1124093612
Name:CRAFT, JEANNE A (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:A
Last Name:CRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17 MELBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2507
Mailing Address - Country:US
Mailing Address - Phone:908-221-1310
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-2322
Practice Address - Fax:973-322-5504
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA062508002083C0008X, 2080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6606601Medicaid
NJ861103Medicare ID - Type Unspecified
NJ6606601Medicaid