Healthcare Provider Details

I. General information

NPI: 1063043404
Provider Name (Legal Business Name): JACOB VOLLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAA TECHNICAL CENTER, BUILDING 350 ATTENTION: MEDICAL
EGG HARBOR TOWNSHIP NJ
08234
US

IV. Provider business mailing address

FAA TECHNICAL CENTER, BUILDING 350 ATTENTION: MEDICAL
EGG HARBOR TOWNSHIP NJ
08234
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-2007
  • Fax: 609-677-2143
Mailing address:
  • Phone: 609-677-2007
  • Fax: 609-677-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: