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NPI Code Detail

MEDICARE: DR. AUDRA MARIE MALERBA D.O.

MEDICARE: DR. AUDRA MARIE MALERBA D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician228668NY
2207NP0225XPediatric Dermatology Physician228668NY
3207NS0135XProcedural Dermatology Physician228668NY

General Provider Information

NPI Number : 1578682985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUDRA MARIE MALERBA D.O.
Provider Business Mailing Address
First Line : 327 E MAIN ST
Second Line :
City : SMITHTOWN
State : NY
Zip : 11787-2905
Country : US
Telephone Number : 631-979-0909
Fax Number : 631-979-0455
Provider Business Practice Location Address
First Line : 327 E MAIN ST
Second Line :
City : SMITHTOWN
State : NY
Zip : 11787-2905
Country : US
Telephone Number : 631-979-0909
Fax Number : 631-979-0455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 09/11/2025

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