Provider Demographics
NPI:1881331452
Name:GJINAJ, ERISA (DO)
Entity type:Individual
Prefix:
First Name:ERISA
Middle Name:
Last Name:GJINAJ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WOODLAND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1230
Mailing Address - Country:US
Mailing Address - Phone:860-714-7362
Mailing Address - Fax:860-714-8140
Practice Address - Street 1:701 COTTAGE GROVE RD STE D110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3085
Practice Address - Country:US
Practice Address - Phone:860-530-2014
Practice Address - Fax:860-242-6840
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT82365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program