| Shoreline Neurology, Llc | |
|
180 Westbrook Rd Building 5 Essex CT 06426-1517 | |
| (860) 767-1034 | |
| (860) 767-3434 |
| Full Name | Shoreline Neurology, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 180 Westbrook Rd, Essex, Connecticut |
| Authorized Official Name and Position | Gang Lian (SOLE MEMBER) |
| Authorized Official Contact | 8607671034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Neurology, Llc 180 Westbrook Rd Building 5 Essex CT 06426-1517 Ph: (860) 767-1034 | Shoreline Neurology, Llc 180 Westbrook Rd Building 5 Essex CT 06426-1517 Ph: (860) 767-1034 |
| NPI Number | 1255653036 |
|---|---|
| Provider Enumeration Date | 02/22/2010 |
| Last Update Date | 02/22/2010 |
| Medicare PECOS PAC ID | 9133259575 |
|---|---|
| Medicare Enrollment ID | O20100611000401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255653036 | NPI | - | NPPES |
| 130000590 | Other | CT | MEDICARE PTAN |
| 001411371 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 041137 (Connecticut) | Primary |
| Provider Name | Gang G Lian |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316956501 PECOS PAC ID: 6305741224 Enrollment ID: I20031204000281 |
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