Provider Demographics
NPI:1700867413
Name:BABUS, GLENN D (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:BABUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2535 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1207
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-984-2642
Practice Address - Street 1:1099 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-984-2642
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0434207LP2900X
MDH0073176207LP2900X
VA0102201908207LP2900X
TNDO0000002111207LP2900X
NJ25MB09495900207LP2900X
NY228217-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02585064Medicaid
NY02585064Medicaid
NY33P251Medicare PIN