39D0199504 CLIA NUMBER - JAN N WIDERMAN DO, FACOP, FAAP, PC

Laboratory Demographics

  • CLIA Code: 39D0199504
  • Facility Name: JAN N WIDERMAN DO, FACOP, FAAP, PC
  • Facility Address: 10800 BUSTLETON AVE
    PHILADELPHIA, PA
    ZIP 19116
  • Facility Phone: 215 934-6777
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAN N. WIDERMAN
  • NPI Number: 1023197977
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D0199504
LAB Type Physician Office
Facility Name JAN N WIDERMAN DO, FACOP, FAAP, PC
Street 10800 BUSTLETON AVE
City PHILADELPHIA
State PA
ZIP 19116
Phone 215 934-6777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director JAN N. WIDERMAN

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This page was last updated on: 9/29/2025