Healthcare Provider Details

I. General information

NPI: 1316956501
Provider Name (Legal Business Name): GANG GARY LIAN M,D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY GANG LIAN M.D., PH.D.

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WESTBROOK RD BUILDING 5
ESSEX CT
06426-1517
US

IV. Provider business mailing address

180 WESTBROOK RD BUILDING 5
ESSEX CT
06426-1517
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-1034
  • Fax: 860-767-3434
Mailing address:
  • Phone: 860-767-1034
  • Fax: 860-767-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number041137
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number041137
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: