NPI 1053507566

Marven Wallen & S. Kenneth Jacobson, MD PA

Organisation General Practice Physician Maplewood, NJ

Practice location

Address: 1985 Springfield Ave, Maplewood, NJ 07040-3435
Phone: (973) 763-5010
Fax: (973) 761-6980

Authorised official

Name: Marven H Wallen
Title: Owner/Administrator
Phone: (973) 763-5010

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X

Other General Practice providers in New Jersey →

Registry record

NPI: 1053507566
Entity type: Organization
NPI issued: 18 Sep 2007
Record last updated: 19 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.