Provider Demographics
NPI:1962051854
Name:GJOKAJ, LIRIDONA
Entity type:Individual
Prefix:
First Name:LIRIDONA
Middle Name:
Last Name:GJOKAJ
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 1:141 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6204
Mailing Address - Country:US
Mailing Address - Phone:845-568-5260
Mailing Address - Fax:845-568-5213
Practice Address - Street 1:141 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6204
Practice Address - Country:US
Practice Address - Phone:845-568-5260
Practice Address - Fax:845-568-5213
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2024-07-03
Deactivation Date:2024-05-09
Deactivation Code:
Reactivation Date:2024-07-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program