Provider Demographics
NPI:1649415878
Name:BEACHSIDE PEDIATRICS
Entity Type:Organization
Organization Name:BEACHSIDE PEDIATRICS
Other - Org Name:BEACHSIDE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-865-5439
Mailing Address - Street 1:1145 KANE CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:33154
Mailing Address - Country:US
Mailing Address - Phone:305-865-5439
Mailing Address - Fax:305-866-5366
Practice Address - Street 1:1145 KANE CONCOURSE
Practice Address - Street 2:
Practice Address - City:BAY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:33154
Practice Address - Country:US
Practice Address - Phone:305-865-5439
Practice Address - Fax:305-866-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center