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:
Health care specialties
| Specialty | Code | License # | 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 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053490805 | NPPES |
| New York | MEDICAID | 00359366 |
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