MEDICARE: CHILDRENS HEALTH SERVICE

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
1	2080A0000X	Pediatric Adolescent Medicine Physician

General Provider Information

NPI Number	:	1205901758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS HEALTH SERVICE

Provider Business Mailing Address
First Line	:	4 GOODHILL RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883
Country	:	US
Telephone Number	:	203-226-3035
Fax Number	:	203-221-1736

Provider Business Practice Location Address
First Line	:	4 GOODHILL RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883
Country	:	US
Telephone Number	:	203-226-3035
Fax Number	:	203-221-1736

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERALD LIEBERMAN
Credential	:	MD
Telephone Number	:	203-226-3035

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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Directions to “CHILDRENS HEALTH SERVICE ” Practice Location

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