Individual provider Active NPI

Taly Glaubach, M.D.

  • Pediatrics Physician
  • Stony Brook, NY
National Provider Identifier
1154553550
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
249239 Issued in NY
Practice address
Dept of Pediatrics HSC T11 060
Stony Brook Children'S Hospital
Stony Brook, NY 11794-8111
Phone
(631) 444-7884
NPI assigned
Aug 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036.124783 IL
Pediatric Hematology & Oncology Physician 2080P0207X 036.124783 IL
Pediatrics Physician 208000000X 249239 NY Primary

Addresses

Primary practice location

Dept of Pediatrics HSC T11 060
Stony Brook Children'S Hospital
Stony Brook, NY 11794-8111

Mailing address

Dept of Pediatrics HSC T11 060
Stony Brook Children'S Hospital
Stony Brook, NY 11794-8111
Phone (631) 444-7884

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170119001890 NY Practitioner - Pediatric Medicine 6103052360 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.124783ILMDPediatrics Physician
249239NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospital at Stony Brook Current Accepting new patients
Stony Brook Children'S Service, University Faculty Practice Corporatio Pediatrics CurrentSince Feb 8, 2017 Accepting new patients

Locations

2701 Sunrise Hwy
Islip Terrace, NY 11752
Phone (631) 444-6300

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: taly.glaubach@direct.stonybrookmedicine.edu

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1154553550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT OF PEDIATRICS HSC T11 060",
            "address_2": "STONY BROOK CHILDREN'S HOSPITAL",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948111",
            "telephone_number": "631-444-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPT OF PEDIATRICS HSC T11 060",
            "address_2": "STONY BROOK CHILDREN'S HOSPITAL",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948111",
            "telephone_number": "631-444-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLAUBACH",
        "first_name": "TALY",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-18",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.124783",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IL",
            "license": "036.124783",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "249239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.