Clack, William Edward

Clack, William Edward is an individual health care provider with primary practice located at 200 Madison Ave Ste 2B , Elmira NY 14901-3219. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Clack, William Edward can be contacted via phone (607) 732-1310.

Contact Information

Primary practice address
200 Madison Ave Ste 2B Elmira NY 14901-3219
Phone: (607) 732-1310
Fax: (607) 733-0940
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 1181211 New York

Profile Details

NPI number 1053490805
LBN Legal business name Clack, William Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2006
Last updated Nov 24th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053490805 NPPES
New York MEDICAID 00359366

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