Provider Demographics
NPI:1801576608
Name:PASTUKHOVA, MARIA (RDN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PASTUKHOVA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WALL ST STE 3303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-4301
Mailing Address - Country:US
Mailing Address - Phone:201-378-3237
Mailing Address - Fax:
Practice Address - Street 1:99 WALL ST STE 3303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-4301
Practice Address - Country:US
Practice Address - Phone:201-378-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX7234133V00000X
MTMED-NUTR-LIC-158808133V00000X
TXDT91541133V00000X
NY011470-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered