Provider Demographics
NPI:1316151863
Name:BRAHAJ, DRIOLA
Entity type:Individual
Prefix:
First Name:DRIOLA
Middle Name:
Last Name:BRAHAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PINEWOOD RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1638
Mailing Address - Country:US
Mailing Address - Phone:718-920-9900
Mailing Address - Fax:718-920-6848
Practice Address - Street 1:41 BREWSTER RD # LEVELA
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5161
Practice Address - Country:US
Practice Address - Phone:860-585-3000
Practice Address - Fax:860-585-3907
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CT047228207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist