Organization
JAN N WIDERMAN P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN N. WIDERMAN DO (PHYSICIAN)
(215) 934-6777
Entity
Organization
Contact information
Practice address
10800 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
(215) 934-6777
(215) 934-6787
Mailing address
10800 BUSTLETON AVE, PHILADELPHIA, PA 19116-3302
(215) 934-6777
(215) 934-6787
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
OS004029L
PA
Other
Enumeration date
11/26/2008
Last updated
11/26/2008
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