# MEDICALLY ASSISTED RECOVERY SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770960882
- **Authorized official:** DR. JAN N WIDERMAN D.O. (PHYSICIAN)
- **Authorized official phone:** (215) 969-6277

## Contact information

- **Practice address:** 10802 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
- **Practice address phone:** (215) 969-6277
- **Practice address fax:** (215) 856-7313
- **Mailing address:** 10802 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
- **Mailing address phone:** (215) 969-6277
- **Mailing address fax:** (215) 856-7313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | OS004029L | PA | Yes |

## Other

- **Enumeration date:** 04/28/2015
- **Last updated:** 07/06/2015