Healthcare Provider Details

I. General information

NPI: 1134012198
Provider Name (Legal Business Name): GRAMOS MEJDOLLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DANBURY RD STE 5
NEW MILFORD CT
06776-3442
US

IV. Provider business mailing address

15 COVINGTON ST APT 219
NEW BRITAIN CT
06053-2177
US

V. Phone/Fax

Practice location:
  • Phone: 860-354-7605
  • Fax: 860-355-0089
Mailing address:
  • Phone: 959-232-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14922
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: