Provider Demographics
NPI:1144250283
Name:GINDI, MICHAEL M (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:GINDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6023
Mailing Address - Country:US
Mailing Address - Phone:732-531-0757
Mailing Address - Fax:
Practice Address - Street 1:290 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:DEAL
Practice Address - State:NJ
Practice Address - Zip Code:07723-1545
Practice Address - Country:US
Practice Address - Phone:732-531-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1577103T00000X
NY5963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ735252Medicare ID - Type UnspecifiedMEDICARE PROVIDER #