Individual
DR. WILLIAM EDWARD CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MADISON AVE STE 2B, ELMIRA, NY 14901-3219
(607) 732-1310
(607) 733-0940
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
(607) 873-1244
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1181211
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00359366
—
NY
Enumeration date
11/03/2006
Last updated
11/24/2020
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