Andrea D. Maller, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV006193-1 Issued in NY

Practice address

2748 Hylan Blvd
Staten Island, NY 10306-4658

Phone

(718) 979-2200

Fax

(718) 979-3435

NPI assigned

Nov 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• General Vision Services LLC

  • Preferred Provider Organization
  • Staten Island, NY
  • NPI 1851467849
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265760000000",
    "number": "1083780233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2748 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064658",
            "telephone_number": "718-979-2200",
            "fax_number": "718-979-3435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2748 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064658",
            "telephone_number": "718-979-2200",
            "fax_number": "718-979-3435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLER",
        "first_name": "ANDREA",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2010-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006193-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "TUV006193-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Luchavez Malinao, O.T.
• Larisa Malisova, DO
• Alaina D Malizia
• Robert W Malizia, MD
• Liubov Malkova
• Sandra A Mallette, RN
• Amanda Nicole Mallia, FNP-BC
• Brianna Frances Mallia, M.S., CCC-SLP
• Daniela Rose Mallia, M.S. OTR/L
• Ali Imran Mallick

• Optometrist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.