Provider Demographics
NPI:1578503405
Name:HOLDCRAFT, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HOLDCRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ROUTE 31 N STE 103
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3605
Mailing Address - Country:US
Mailing Address - Phone:609-730-1771
Mailing Address - Fax:609-730-1274
Practice Address - Street 1:84 ROUTE 31 N STE 103
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-3605
Practice Address - Country:US
Practice Address - Phone:609-730-1771
Practice Address - Fax:609-730-1274
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04461100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1664107Medicaid
NJ483019V6MMedicare PIN
C53968Medicare UPIN