Provider Demographics
NPI:1295888097
Name:KRAFT, SAMARA (MS,RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:SAMARA
Middle Name:
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HAMPTON HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PERRINEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-1004
Mailing Address - Country:US
Mailing Address - Phone:732-309-8936
Mailing Address - Fax:732-254-5396
Practice Address - Street 1:503 CRANBURY ROAD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-309-8936
Practice Address - Fax:732-254-5396
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ869731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
080513Medicare ID - Type Unspecified