Provider Demographics
NPI:1417906066
Name:LAUB, GLENN W (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:W
Last Name:LAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7441
Mailing Address - Country:US
Mailing Address - Phone:609-712-7972
Mailing Address - Fax:609-543-2453
Practice Address - Street 1:2 STOUT RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-712-7972
Practice Address - Fax:609-543-2453
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05182700208G00000X
PAMD070314L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1000338800OtherAMERICHOICE
NJ418181000OtherAMERIHEALTH
NJ2026938OtherUNITED HEALTHCARE
NJ418181000OtherKEYSTONE HEALTHPLAN
NJ595777PDMOtherINDEPENDENT BCBS
NJ2337125OtherAETNA
NJP390840OtherOXFORD
NJ1130387OtherHORIZON NJ HEALTH
NJ83490OtherAMERIGROUP
NJ0584908Medicaid
NJ29208OtherUNIVERSITY HEALTH PLAN
NJ1K6468OtherHEALTHNET/PHS
780001881OtherRR MEDICARE
NJ29208OtherUNIVERSITY HEALTH PLAN
780001881OtherRR MEDICARE