Healthcare Provider Details

I. General information

NPI: 1326531435
Provider Name (Legal Business Name): OLEG NECHYPORUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2489
US

IV. Provider business mailing address

624 MCCLELLAN ST STE 101
SCHENECTADY NY
12304-1020
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4135
  • Fax: 518-347-5196
Mailing address:
  • Phone: 518-347-5043
  • Fax: 518-347-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number311802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: