Individual provider Active NPI

Liang Shao, PH.D

  • Clinical Psychologist
  • Brooklyn, NY
National Provider Identifier
1972570851
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
015647 Issued in NY
Practice address
451 Clarkson Ave
Brooklyn, NY 11203-2057
Phone
(718) 245-2272
Fax
(718) 771-1706
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 015647 NY
Clinical Psychologist 103TC0700X 015647 NY Primary

Addresses

Primary practice location

451 Clarkson Ave
Brooklyn, NY 11203-2057

Mailing address

1745 Broadway
17 FL
New York, NY 10019-4640
Phone (212) 851-8100

Other identifiers 1

IdentifierTypeStateIssuer
02432162MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040325001695 NY Practitioner - Clinical Psychologist 8123910007 Practice locations: Rego Park, NY; Flushing, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
015647NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Life Management, P.L.L.C. Clinical Past Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434326400000",
    "number": "1972570851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 BROADWAY",
            "address_2": "17 FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194640",
            "telephone_number": "212-851-8100",
            "fax_number": "212-537-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032057",
            "telephone_number": "718-245-2272",
            "fax_number": "718-771-1706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAO",
        "first_name": "LIANG",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2015-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "015647",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02432162",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.