| Organization Name: | MARVEN WALLEN & S. KENNETH JACOBSON, MD PA |
| NPI Number: | 1053507566 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARVEN H WALLEN (OWNER/ADMINISTRATOR) |
| Mailing Address: | 1985 Springfield Ave Maplewood |
| State: | NJ US |
| Postal Code: | 070403435 |
| Phone Number: | 9737635010 |
| Fax Number: | 9737616980 |
| NPI Enumeration Date: | 09/18/2007 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |