OrganizationActive
Medically Assisted Recovery Services Inc
NPI 1770960882 · Addiction Medicine (Internal Medicine) Physician · Philadelphia, PA
Provider details
- NPI number
- 1770960882
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Jan Widerman, Physician
- License
- OS004029L (PA)
Practice location
10802 Bustleton Ave
Philadelphia, PA 19116-3302
Phone: (215) 969-6277
Fax: (215) 856-7313
Mailing address
10802 Bustleton Ave
Philadelphia, PA 19116-3302
Registry dates
- Enumerated
- 2015-04-28
- Last updated
- 2015-07-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.