Individual
IVAN SHVACHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 NOTT ST, SCHENECTADY, NY 12308-2425
(518) 243-4000
Mailing address
1462 ERIE BLVD, SUITE 2, SCHENECTADY, NY 12305-1026
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
240695
NY
207R00000X
Internal Medicine Physician
240695
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000411953001
BSNENY
NY
01
—
070209000089
FIDELIS CARE
NY
01
—
10115093
CDPHP
NY
01
—
11568824
CAQH
—
01
—
240SD1
BLUE CROSS
NY
01
—
4149461
MVP
NY
Enumeration date
07/12/2006
Last updated
09/11/2025
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