Organization
SOVEREIGN MEDICAL GROUP LLC
Active
Parent organization
SOVEREIGN MEDICAL GROUP LLC
Other names
Urology Specialtly Care PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOVEREIGN MEDICAL GROUP LLC
Authorized official
JOHN H HAJJAR MD (OWNER)
(201) 791-4544
Entity
Organization
Contact information
Practice address
15-01 BROADWAY, SUITE 1 & 3, FAIR LAWN, NJ 07410
(201) 791-4544
(201) 794-6970
Mailing address
85 HARRISTOWN RD FL 2, GLEN ROCK, NJ 07452-3329
(201) 855-8446
(201) 444-0350
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207ZC0006X
Clinical Pathology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7586205
—
NJ
Enumeration date
04/06/2011
Last updated
05/31/2018
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