Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.124783 | IL |
Y | 208000000X | Pediatrician | 249239 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 036.124783 | IL |
NPI | 1154553550 |
---|---|
Provider Name | Ms. Taly Glaubach |
First Address | Stony Brook, NY 11794-8111 |
Second Address | Stony Brook, NY 11794-8111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 22/03/2017 |