Organization
SOVEREIGN MEDICAL GROUP LLC
Active
Parent organization
SOVEREIGN MEDICAL GROUP LLC
Other names
Jersey City Radiation Therapy LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOVEREIGN MEDICAL GROUP LLC
Authorized official
DONALD VARDARO (ADMINISTRATIVE DIRECTOR)
(201) 880-7580
Entity
Organization
Contact information
Practice address
631 GRAND STREET, SUITE 1-1, JERSEY CITY, NJ 07304
(201) 880-7580
(201) 880-7585
Mailing address
631 GRAND STREET, SUITE 1-1, JERSEY CITY, NJ 07304
(201) 880-7580
(201) 880-7585
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Enumeration date
04/06/2011
Last updated
06/09/2011
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