Provider Demographics
NPI:1992061261
Name:KRONGOLD, SAMANTHA ANNE (BLA, OTR/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANNE
Last Name:KRONGOLD
Suffix:
Gender:F
Credentials:BLA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RAINBOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-3905
Mailing Address - Country:US
Mailing Address - Phone:908-371-1157
Mailing Address - Fax:
Practice Address - Street 1:141 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1803
Practice Address - Country:US
Practice Address - Phone:908-725-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00350900225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics