Provider Demographics
NPI:1154553550
Name:GLAUBACH, TALY (MD)
Entity type:Individual
Prefix:MS
First Name:TALY
Middle Name:
Last Name:GLAUBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF PEDIATRICS HSC T11 060
Mailing Address - Street 2:STONY BROOK CHILDREN'S HOSPITAL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-7884
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF PEDIATRICS HSC T11 060
Practice Address - Street 2:STONY BROOK CHILDREN'S HOSPITAL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124783208000000X, 2080P0207X
NY249239208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology