Basic Information
| Provider Information | |||||||||
| NPI: | 1578503405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLDCRAFT | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 ROUTE 31 N STE 103 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085343605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097301771 | ||||||||
| FaxNumber: | 6097301274 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 ROUTE 31 N STE 103 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085343605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097301771 | ||||||||
| FaxNumber: | 6097301274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 12/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA04461100 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1664107 | 05 | NJ | MEDICAID |