Individual
JANET WIDERSPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 LARCH LN, MASSAPEQUA PARK, NY 11762-3924
(516) 804-4899
Mailing address
PO BOX 212, MASSAPEQUA PARK, NY 11762-0212
(516) 804-4899
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
209672
NY
207Q00000X
Family Medicine Physician
A64617
CA
207Q00000X
Family Medicine Physician
K3658
TX
Other
Enumeration date
04/23/2010
Last updated
04/23/2010
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