# MARVEN WALLEN & S. KENNETH JACOBSON, MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053507566
- **Authorized official:** DR. MARVEN H WALLEN M.D. (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (973) 763-5010

## Contact information

- **Practice address:** 1985 SPRINGFIELD AVE, MAPLEWOOD, NJ 07040-3435
- **Practice address phone:** (973) 763-5010
- **Practice address fax:** (973) 761-6980
- **Mailing address:** 1985 SPRINGFIELD AVE, MAPLEWOOD, NJ 07040-3435
- **Mailing address phone:** (973) 763-5010
- **Mailing address fax:** (973) 761-6980

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NJ | Yes |

## Other

- **Enumeration date:** 09/18/2007
- **Last updated:** 06/19/2008