Healthcare Provider Details

I. General information

NPI: 1104734631
Provider Name (Legal Business Name): DOROTHY A GINDA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S HOLMDEL RD
HOLMDEL NJ
07733-2130
US

IV. Provider business mailing address

35 KINGS HWY
MIDDLETOWN NJ
07748-2503
US

V. Phone/Fax

Practice location:
  • Phone: 732-639-0172
  • Fax:
Mailing address:
  • Phone: 732-804-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01477500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: