Marven Wallen & S. Kenneth Jacobson, MD PA

NPI #1053507566 in Maplewood, New Jersey

Provider Information

NPI Number: 1053507566
Entity Type: Organization
Organization Name: Marven Wallen & S. Kenneth Jacobson, MD PA
Primary Specialty: General Practice
Enumeration Date: Sep 18, 2007
Last Updated: Jun 19, 2008

Practice Location

Address: 1985 SPRINGFIELD AVE
City: Maplewood
State: New Jersey
ZIP Code: 07040-3435
Phone: (973) 763-5010

Authorized Official

Name: DR. MARVEN H WALLEN, M.D.
Title: OWNER/ADMINISTRATOR
Phone: (973) 763-5010

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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