Healthcare Provider Details

I. General information

NPI: 1881331452
Provider Name (Legal Business Name): ERISA GJINAJ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COTTAGE GROVE RD STE D110
BLOOMFIELD CT
06002-3085
US

IV. Provider business mailing address

95 WOODLAND ST FL 1
HARTFORD CT
06105-1230
US

V. Phone/Fax

Practice location:
  • Phone: 860-530-2014
  • Fax: 860-242-6840
Mailing address:
  • Phone: 860-714-7362
  • Fax: 860-714-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82365
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: