Organization
MEDICALLY ASSISTED RECOVERY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN N WIDERMAN D.O. (PHYSICIAN)
(215) 969-6277
Entity
Organization
Contact information
Practice address
10802 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
(215) 969-6277
(215) 856-7313
Mailing address
10802 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
(215) 969-6277
(215) 856-7313
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
OS004029L
PA
Other
Enumeration date
04/28/2015
Last updated
07/06/2015
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