Provider Demographics
NPI:1578682985
Name:MALERBA, AUDRA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:MARIE
Last Name:MALERBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2905
Mailing Address - Country:US
Mailing Address - Phone:631-979-0909
Mailing Address - Fax:631-979-0455
Practice Address - Street 1:327 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2905
Practice Address - Country:US
Practice Address - Phone:631-979-0909
Practice Address - Fax:631-979-0455
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228668207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI00579Medicare UPIN