DR. JAN NEIL WIDERMAN D.O. NPI 1023197977

NPI Information

  • NPI: 1023197977
  • Provider Name: DR. JAN NEIL WIDERMAN, D.O.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • CLIA Number: 39D0199504
  • Address: 10800 BUSTLETON AVE
    PHILADELPHIA, PA
    ZIP 19116
  • Phone: (215) 934-6777

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NPI Details

DR. Jan Neil Widerman, D.O. is a pediatrics in Philadelphia, PA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DR. Jan Neil Widerman, D.O. NPI is 1023197977. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

10800 BUSTLETON AVE
PHILADELPHIA, PA
ZIP 19116-302
Phone: (215) 934-6777
Fax: (215) 934-6787

The NPI 1023197977 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 39D0199504 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2006 and was last updated on 2/20/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsOS004029LPENNSYLVANIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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