Healthcare Provider Details

I. General information

NPI: 1124093612
Provider Name (Legal Business Name): JEANNE A CRAFT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD PEDIATRIC INTENSIVE CARE UNIT
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

17 MELBOURNE WAY
BASKING RIDGE NJ
07920-2507
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-2322
  • Fax: 973-322-5504
Mailing address:
  • Phone: 908-221-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number25MA06250800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA06250800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06250800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: