Individual
JEAN PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
405 LOCUST AVE, OAKDALE, NY 11769-1651
(631) 868-1254
(631) 567-1648
Mailing address
405 LOCUST AVE, OAKDALE, NY 11769-1651
(631) 868-1254
(631) 567-1648
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
738682-01
NY
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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