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Organization
SOVEREIGN HEALTH IMAGING, LLC
Active
Organization
SOVEREIGN HEALTH IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN H. HAJJAR MD (OWNER)
(201) 372-1020
Entity
Organization
Contact information
Practice address
630 BROAD ST, LOWER LEVEL, CARLSTADT, NJ 07072-1169
(201) 372-1020
(201) 372-1028
Mailing address
85 HARRISTOWN RD, 2ND FLOOR, GLEN ROCK, NJ 07452-3329
(201) 703-5500
(201) 703-5564
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1254002
WELLCARE
NJ
01
—
60174608
HORIZON NJ HEALTH
NJ
Enumeration date
10/22/2015
Last updated
10/12/2017
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