Marven Wallen & S. Kenneth Jacobson, MD PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MARVEN WALLEN & S. KENNETH JACOBSON, MD PA

Practice address

1985 Springfield Ave
Maplewood, NJ 07040-3435

Phone

(973) 763-5010

Fax

(973) 761-6980

NPI assigned

Sep 18, 2007

Last updated

Jun 19, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marven H Wallen, M.D.NPI 1730231234

Title

Owner/Administrator

Phone

(973) 763-5010

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marven H Wallen, M.D.

  • Internal Medicine Physician
  • Maplewood, NJ
  • NPI 1730231234
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1053507566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 SPRINGFIELD AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403435",
            "telephone_number": "973-763-5010",
            "fax_number": "973-761-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 SPRINGFIELD AVE",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403435",
            "telephone_number": "973-763-5010",
            "fax_number": "973-761-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVEN WALLEN & S. KENNETH JACOBSON, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "WALLEN",
        "authorized_official_first_name": "MARVEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "973-763-5010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• General Practice Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.