Healthcare Provider Details

I. General information

NPI: 1700936135
Provider Name (Legal Business Name): CHER A PASTORE RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PARK AVE CAP NUTRITION, LLC
NEW YORK NY
10016-3467
US

IV. Provider business mailing address

155 E 34TH ST APT 5J
NEW YORK NY
10016-4756
US

V. Phone/Fax

Practice location:
  • Phone: 212-532-1305
  • Fax: 212-679-6160
Mailing address:
  • Phone: 212-532-1305
  • Fax: 212-679-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005593-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: