Medically Assisted Recovery Services Inc

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

OS004029L Issued in PA

Legal business name

MEDICALLY ASSISTED RECOVERY SERVICES INC

Practice address

10802 Bustleton Ave
Philadelphia, PA 19116-3302

Phone

(215) 969-6277

Fax

(215) 856-7313

NPI assigned

Apr 28, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jan N Widerman, D.O.

Title

Physician

Phone

(215) 969-6277

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1770960882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10802 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163302",
            "telephone_number": "215-969-6277",
            "fax_number": "215-856-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191163302",
            "telephone_number": "215-969-6277",
            "fax_number": "215-856-7313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICALLY ASSISTED RECOVERY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-28",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "WIDERMAN",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "215-969-6277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "PA",
            "license": "OS004029L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Guardian, LLC
• Medical Nutrition Consulting of Media LLC
• Medical Psychiatric Associates of Delaware Valley
• Medical Services of Pennsylvania, PLLC
• Medical Services of Suffolk County PC
• Monica P Medina McCurdy, PA-C
• Angelica Elena Medina Montanez
• Andrea Medina, MD
• Elise Marie Medina
• Loni Medina

• Addiction Medicine (Internal Medicine) Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Addiction Medicine (Internal Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.