Most Relevant Information
Provider Data
| NPI Number: | 1003540923 |
| Provider Name: | JEAN PENDERGAST RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WP0808X |
| Specialty: | Registered Nurse |
| License Number: | 738682-01 |
Most Important Dates
| Enumeration Date: | 07/15/2022 |
| Last Updated: | 07/15/2022 |
Provider Practice Location
405 LOCUST AVE
OAKDALE
NY
117691651
Practice Location Phone/Fax
| Phone: | 6318681254 |
| Fax: | 6315671648 |
Provider Mailing Location
405 LOCUST AVE
OAKDALE
NY
117691651
Provider Mailing Phone/Fax
| Phone: | 6318681254 |
| Fax: | 6315671648 |