MEDICARE: BEACHSIDE PEDIATRICS

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	174400000X	Specialist

General Provider Information

NPI Number	:	1265649990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHSIDE PEDIATRICS

Provider Business Mailing Address
First Line	:	1145 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2012
Country	:	US
Telephone Number	:	305-865-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2012
Country	:	US
Telephone Number	:	305-865-5439
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANDY LIEBERMAN
Credential	:	MD
Telephone Number	:	305-865-5439

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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Directions to “BEACHSIDE PEDIATRICS ” Practice Location

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