Healthcare Provider Details

I. General information

NPI: 1649415878
Provider Name (Legal Business Name): BEACHSIDE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 KANE CONCOURSE
BAY HARBOR FL
33154
US

IV. Provider business mailing address

1145 KANE CONCOURSE
BAY HARBOR FL
33154
US

V. Phone/Fax

Practice location:
  • Phone: 305-865-5439
  • Fax: 305-866-5366
Mailing address:
  • Phone: 305-865-5439
  • Fax: 305-866-5366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDY LIEBERMAN
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 305-865-5439