Provider Demographics
NPI:1548435910
Name:ANDERSON, JAMES WILLIAM (ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SILOAM RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8605
Mailing Address - Country:US
Mailing Address - Phone:732-299-6562
Mailing Address - Fax:
Practice Address - Street 1:765 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1543
Practice Address - Country:US
Practice Address - Phone:732-224-2755
Practice Address - Fax:732-224-2155
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001433002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer