Dr. William Edward Clack
Dermatologist
200 Madison Ave Ste 2b
Elmira
, New York 14901-3219
Dr. William Edward Clack
Dermatologist
200 Madison Ave Ste 2b
Elmira
, New York 14901-3219
(607) 873-1244
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Dr. William Edward Clack
- 571 Saint Josephs Blvd Fl 2
- Elmira, NY
- Zip : 14901-3230
- Fax : (607) 873-1244
- Phone : (607) 271-2050
Second Address
- Dr. William Edward Clack
- 200 Madison Ave Ste 2b
- Elmira, NY
- Zip : 14901-3219
- Fax : (607) 733-0940
- Phone : (607) 732-1310
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 1181211 | NY |
National Provider Identifier
| NPI | 1053490805 |
|---|---|
| Provider Name | Dr. William Edward Clack |
| First Address | Elmira, NY 14901-3230 |
| Second Address | Elmira, NY 14901-3219 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/11/2006 |
| Last Update Date | 24/11/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00359366 | (05) | NY |
| B80199 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.