| NPI | 1770960882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN N WIDERMAN Physician 215-969-6277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PA OS004029L) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-07-06 |