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NPI Code Detail

MEDICARE: DR. MARVEN H WALLEN M.D.

MEDICARE: DR. MARVEN H WALLEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician25MA01881900NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730231234
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVEN H WALLEN M.D.
Provider Business Mailing Address
First Line : 1985 SPRINGFIELD AVE
Second Line :
City : MAPLEWOOD
State : NJ
Zip : 07040-3435
Country : US
Telephone Number : 973-763-5010
Fax Number : 973-761-6980
Provider Business Practice Location Address
First Line : 1985 SPRINGFIELD AVE
Second Line :
City : MAPLEWOOD
State : NJ
Zip : 07040-3435
Country : US
Telephone Number : 973-763-5010
Fax Number : 973-761-6980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/08/2007

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