Organization
SHORELINE NEUROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GANG LIAN M.D., PH.D. (SOLE MEMBER)
(860) 767-1034
Entity
Organization
Contact information
Practice address
180 WESTBROOK RD, BUILDING 5, ESSEX, CT 06426-1517
(860) 767-1034
(860) 767-3434
Mailing address
180 WESTBROOK RD, BUILDING 5, ESSEX, CT 06426-1517
(860) 767-1034
(860) 767-3434
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
041137
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001411371
—
CT
01
—
130000590
MEDICARE PTAN
CT
Enumeration date
02/22/2010
Last updated
02/22/2010
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