Provider Demographics
NPI:1205901758
Name:CHILDRENS HEALTH SERVICE
Entity type:Organization
Organization Name:CHILDRENS HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-226-3035
Mailing Address - Street 1:4 GOODHILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883
Mailing Address - Country:US
Mailing Address - Phone:203-226-3035
Mailing Address - Fax:203-221-1736
Practice Address - Street 1:4 GOODHILL RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883
Practice Address - Country:US
Practice Address - Phone:203-226-3035
Practice Address - Fax:203-221-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty