1700936135 NPI number — CHER A PASTORE RD, CDE

Table of content: CHER A PASTORE RD, CDE (NPI 1700936135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700936135 NPI number — CHER A PASTORE RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASTORE
Provider First Name:
CHER
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700936135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 E 34TH ST APT 5J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-4756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-532-1305
Provider Business Mailing Address Fax Number:
212-679-6160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 PARK AVE
Provider Second Line Business Practice Location Address:
CAP NUTRITION, LLC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-532-1305
Provider Business Practice Location Address Fax Number:
212-679-6160
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  005593-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2369233 . This is a "UNITED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2951573002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7113496 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9533E1 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 184616P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2989242 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C8268 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: HIP . This is a "00559348" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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