Healthcare Provider Details

I. General information

NPI: 1154268837
Provider Name (Legal Business Name): THURSTON ANDERSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PARAMUS RD
PARAMUS NJ
07652-1309
US

IV. Provider business mailing address

113 E CENTRE ST APT 1001
NUTLEY NJ
07110-5419
US

V. Phone/Fax

Practice location:
  • Phone: 201-251-9600
  • Fax:
Mailing address:
  • Phone: 973-907-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00429300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: