Basic Information
| Provider Information | |||||||||
| NPI: | 1700867413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABUS | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2535 ARTHUR KILL RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103091207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184483210 | ||||||||
| FaxNumber: | 7189842642 | ||||||||
| Practice Location | |||||||||
| Address1: | 1099 TARGEE ST | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184483210 | ||||||||
| FaxNumber: | 7189842642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | J0434 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | H0073176 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 0102201908 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | DO0000002111 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 25MB09495900 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 228217-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.