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General NPI Number Information
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NPI Number | 1154268837
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Entity Type | Individual
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Provider Name | THURSTON ANDERSON JR.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 186 PARAMUS RD
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City | PARAMUS
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State | NJ
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Zip | 07652-1309
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Country | US
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Telephone | 201-251-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 113 E CENTRE ST APT 1001
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City | NUTLEY
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State | NJ
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Zip | 07110-5419
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Country | US
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Telephone | 973-907-3725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00429300
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License Number State | NJ
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