DR. WILLIAM EDWARD CLACK (NPI# 1053490805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053490805 |
| Entity Type | Individual |
| Full Name | DR. WILLIAM EDWARD CLACK |
| Credential | MD |
| Practice Address |
200 Madison Ave Ste 2b Elmira NY 14901-3219 |
| Mailing Address |
600 Roe Ave Elmira NY 14905-1629 |
| Practice Telephone | 6077321310 |
| Practice Fax Number | 6077330940 |
| Mailing Telephone | 6077377732 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-10-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 1181211 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00359366 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669471744 | William Pearson Clack | Pathology | 2001 Webber St, Sarasota, FL 34239-5288 | 2005-07-20 |
| Street Address |
200 MADISON AVE STE 2B |
| City | ELMIRA |
| State | NY |
| Zip Code | 14901-3219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497275242 | Esra Salah Shermadou | Family Medicine | 200 Madison Ave, Elmira, NY 14901 | 2017-06-22 |
| 1477967982 | Constantino George Lambroussis | Family Medicine | 200 Madison Ave, Suite 2b, Elmira, NY 14901-3218 | 2014-06-12 |
| 1144522996 | Jessica Anne Gonzalez | Nurse Practitioner | 200 Madison Ave, Suite 2d, Elmira, NY 14901-3218 | 2010-11-30 |
| 1366759045 | Coveney Fitzsimmons | Family Medicine | 200 Madison Ave, Suite 2b, Elmira, NY 14901-3218 | 2010-09-02 |
| 1518279140 | Pedro Juan Gonzalez Zayas | Internal Medicine | 200 Madison Ave, 3rd Floor, Elmira, NY 14901-3218 | 2010-07-12 |
| 1275869869 | Guthrie Clinic Ltd | Clinic/Center | 200 Madison Ave, Suite 2c, Elmira, NY 14901-3218 | 2009-11-02 |
| 1558590067 | Mohamed Omar Atwaibi | Internal Medicine | 200 Madison Ave, Suite 2c, Elmira, NY 14901-3218 | 2009-07-06 |
| 1750573853 | Guthrie Clinic, Ltd. | Durable Medical Equipment & Medical Supplies | 200 Madison Ave, Suite 2c, Elmira, NY 14901-3218 | 2007-08-13 |
| 1659582922 | Benjamin A. Oakes | Physician Assistant | 200 Madison Ave, 3rd Floor, Elmira, NY 14901-3218 | 2007-05-25 |
| 1265659197 | John Witherspoon Alves | Family Medicine | 200 Madison Ave, Suite 2b, Elmira, NY 14901-3218 | 2007-04-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447818182 | Davida Reane Moss | Case Manager/Care Coordinator | 310 Pensyvania Avenue, Elmira, NY 14901 | 2019-05-29 |
| 1316504889 | Jessica Leigh Badilla | Counselor | 1013 Water St, Elmira, NY 14901 | 2019-05-21 |
| 1427508811 | Cynthia Ann Sullivan | Counselor | 1019 E. Water Street, Elmira, NY 14901 | 2016-10-10 |
| 1508313362 | Kim Burlew | Case Manager/Care Coordinator | 1019 W. Water Street Family Services of Chemung County, Elmire, NY 14901 | 2016-09-08 |
| 1396195095 | State of New York Comptrollers Office | Clinic/Center | 164 Sullivan Street, Elmira, NY 14901 | 2016-06-14 |
| 1285089581 | Tasha R Miller | Licensed Practical Nurse | 426 Woodawn Ct, Elmira, NY 14901 | 2016-04-25 |
| 1750628111 | Kelly E Bartle-bush | Social Worker | 711 Sullivan St., Elmira, NY 14901 | 2013-01-04 |
| 1144594946 | Brian Mustico | Occupational Therapist | 512 West Clinton Street, Apartment B, Elmira, NY 14901 | 2012-02-27 |
| 1063780880 | Deidre Ann Callaghan | Physical Therapy Assistant | 555 St.josephs Blvd, Elmira, NY 14901 | 2011-12-07 |
| 1972889467 | Arnot Health | General Acute Care Hospital | 1 St.joseph's Blvd., Elmira, NY 14901 | 2011-10-27 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225636384 | Markowitz Medical Pllc | Dermatology | 1150 5th Ave # Suire1a, New York, NY 10128-0724 | 2020-10-12 |
| 1114545985 | Tarek Yamany Md Pllc | Dermatology | 229 W 60th St Apt 8e, New York, NY 10023-7507 | 2020-07-08 |
| 1952924839 | Elizabeth Jessica Ranelli | Dermatology | 16 W 17th St, New York, NY 10011-5738 | 2020-05-26 |
| 1841811148 | Stuart Daniel Shanler | Dermatology | 53 Underhill Dr, Pomona, NY 10970-2668 | 2020-04-28 |
| 1740800309 | Ns Arora Dermatology Pllc | Dermatology | 99 Jericho Tpke Ste 110, Jericho, NY 11753-1015 | 2020-04-23 |
| 1174163406 | Halite Services Crop | Dermatology | 447 Rose Ln, Rockville Centre, NY 11570-1429 | 2020-01-15 |
| 1235776485 | Libby Rhee Do Dermatology Pllc | Dermatology | 110 E 60th St # 800, New York, NY 10022-1688 | 2019-12-06 |
| 1588214357 | Advanced Dermatology of New York PC | Dermatology | 1-3 West 125th Street, New York, NY 10027 | 2019-09-13 |
| 1568018588 | Mary Matina Valinotti | Dermatology | 332 E Main St Ste 1, Bay Shore, NY 11706-8436 | 2019-08-15 |
| 1831751379 | Jessica Weiser, M.d., Pllc | Dermatology | 155 Spring St Fl 5, New York, NY 10012-5208 | 2019-07-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.