Provider Demographics
NPI:1811546179
Name:XIANG, SHANG (OD)
Entity type:Individual
Prefix:
First Name:SHANG
Middle Name:
Last Name:XIANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 LEROY PL APT 1C
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1722
Mailing Address - Country:US
Mailing Address - Phone:857-333-6903
Mailing Address - Fax:
Practice Address - Street 1:279 3RD AVE STE 204
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6210
Practice Address - Country:US
Practice Address - Phone:732-222-7373
Practice Address - Fax:732-222-7372
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00692600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist