Organization
SOVEREIGN MEDICAL GROUP LLC
Active
Parent organization
SOVEREIGN MEDICAL GROUP LLC
Other names
New Jersey Institute of Radiology PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOVEREIGN MEDICAL GROUP LLC
Authorized official
JOHN H HAJJAR MD (CEO)
(201) 791-4544
Entity
Organization
Contact information
Practice address
630 BROAD ST, CARLSTADT, NJ 07072-1169
(201) 372-1020
(201) 372-1028
Mailing address
630 BROAD ST, CARLSTADT, NJ 07072-1169
(201) 372-1020
(201) 372-1028
Taxonomy
Speciality
Code
Description
License number
State
207UN0901X
Nuclear Cardiology Physician
—
—
207UN0902X
Nuclear Imaging & Therapy Physician
—
—
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0133311
—
NJ
Enumeration date
04/06/2011
Last updated
06/09/2011
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