Healthcare Provider Details

I. General information

NPI: 1265649990
Provider Name (Legal Business Name): BEACHSIDE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2012
US

IV. Provider business mailing address

1145 KANE CONCOURSE
BAY HARBOR ISLANDS FL
33154-2012
US

V. Phone/Fax

Practice location:
  • Phone: 305-865-5439
  • Fax:
Mailing address:
  • Phone: 305-865-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SANDY LIEBERMAN
Title or Position: OWNER
Credential: MD
Phone: 305-865-5439