MEDICARE: OLEG NECHYPORUK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	311802	NY

General Provider Information

NPI Number	:	1326531435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLEG NECHYPORUK M.D.

Provider Business Mailing Address
First Line	:	624 MCCLELLAN ST STE 101
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-1020
Country	:	US
Telephone Number	:	518-347-5043
Fax Number	:	518-347-5196

Provider Business Practice Location Address
First Line	:	1101 NOTT ST
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-2489
Country	:	US
Telephone Number	:	518-243-4135
Fax Number	:	518-347-5196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	09/27/2021

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