Provider Demographics
NPI:1023093879
Name:PRENDERGAST, NANCY CECILE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CECILE
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:264 AMBOY AVE
Practice Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2441
Practice Address - Country:US
Practice Address - Phone:732-548-2322
Practice Address - Fax:732-548-3392
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2011-01-05
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA027971002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8714401Medicaid
NY01511908Medicaid
NJ8714401Medicaid
F50212Medicare UPIN