Provider Demographics
NPI:1134012198
Name:MEJDOLLI, GRAMOS
Entity type:Individual
Prefix:
First Name:GRAMOS
Middle Name:
Last Name:MEJDOLLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COVINGTON ST APT 219
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2177
Mailing Address - Country:US
Mailing Address - Phone:959-232-8556
Mailing Address - Fax:
Practice Address - Street 1:116 DANBURY RD STE 5
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3442
Practice Address - Country:US
Practice Address - Phone:860-354-7605
Practice Address - Fax:860-355-0089
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist