| Marven Wallen & S. Kenneth Jacobson, Md Pa | |
|
1985 Springfield Ave Maplewood NJ 07040-3435 | |
| (973) 763-5010 | |
| (973) 761-6980 |
| Full Name | Marven Wallen & S. Kenneth Jacobson, Md Pa |
|---|---|
| Speciality | General Practice |
| Location | 1985 Springfield Ave, Maplewood, New Jersey |
| Authorized Official Name and Position | Marven H Wallen (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 9737635010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marven Wallen & S. Kenneth Jacobson, Md Pa 1985 Springfield Ave Maplewood NJ 07040-3435 Ph: (973) 763-5010 | Marven Wallen & S. Kenneth Jacobson, Md Pa 1985 Springfield Ave Maplewood NJ 07040-3435 Ph: (973) 763-5010 |
| NPI Number | 1053507566 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 06/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053507566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (New Jersey) | Primary |
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