Individual
MR. JOHN JOSEPH PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
246 FEDERAL RD, UNIT D-12, BROOKFIELD, CT 06804-2647
(203) 775-3290
(203) 775-6970
Mailing address
246 FEDERAL RD, UNIT D-12, BROOKFIELD, CT 06804-2647
(203) 775-3290
(203) 775-6970
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000219
CT
Other
Enumeration date
12/29/2006
Last updated
07/08/2007
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