Shoreline Neurology, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

041137 Issued in CT

Legal business name

SHORELINE NEUROLOGY, LLC

Practice address

180 Westbrook Rd
Building 5
Essex, CT 06426-1517

Phone

(860) 767-1034

Fax

(860) 767-3434

NPI assigned

Feb 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gang Lian, M.D., PH.D.NPI 1316956501

Title

Sole Member

Phone

(860) 767-1034

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gang Gary Lian, M,D., PH.D.

  • Neurology Physician
  • Essex, CT
  • NPI 1316956501
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266796800000",
    "number": "1255653036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 WESTBROOK RD",
            "address_2": "BUILDING 5",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261517",
            "telephone_number": "860-767-1034",
            "fax_number": "860-767-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WESTBROOK RD",
            "address_2": "BUILDING 5",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261517",
            "telephone_number": "860-767-1034",
            "fax_number": "860-767-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE NEUROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-22",
        "last_updated": "2010-02-22",
        "status": "A",
        "authorized_official_last_name": "LIAN",
        "authorized_official_first_name": "GANG",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "860-767-1034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "041137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "130000590",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001411371",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael M. Sasportas, M.S.W.
• Moheba Sayed, LPC
• Michele Marie Schavoir, RN, CDOE
• Susan A Scott, LMFT
• Emily M Searle, DPT
• Shoreline Orthopedic Rehabilitation
• Shoreline Orthopedics & Sports Medicine, LLC
• Lisa R. Silberstein, PH.D.
• Lynn M Smith, APRN
• Sound Counseling Center LLC

• Neurology Physician in Essex, CT
• Providers in Essex, CT by specialty
• Neurology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.