SOVEREIGN MEDICAL GROUP LLC (NPI# 1114216660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114216660 |
| Entity Type | Organization |
| Organization Name | SOVEREIGN MEDICAL GROUP LLC |
| Other Organization Name | JERSEY CITY RADIATION THERAPY LLC |
| Practice Address |
631 Grand Street Suite 1-1 Jersey City NJ 07304 |
| Practice Telephone | 2018807580 |
| Practice Fax Number | 2018807585 |
| Mailing Telephone | 2018807580 |
| Mailing Fax Number | 2018807585 |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-06-09 |
| Authorized Official Name | DONALD VARDARO (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 2018807580 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOVEREIGN MEDICAL GROUP LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jersey City Radiation Therapy LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710282082 | Sovereign Medical Group LLC | Radiology | 85 Harristown Rd Fl 2, Glen Rock, NJ 07452-3329 | 2011-01-18 |
| 1669761110 | Sovereign Medical Group LLC | Radiology | 20 Woodridge Ave, Hackensack, NJ 07601-6013 | 2011-04-06 |
| 1205125655 | Sovereign Medical Group LLC | Internal Medicine | 15-01 Broadway, Suite 1 & 3, Fair Lawn, NJ 07410 | 2011-04-06 |
| 1841589298 | Sovereign Medical Group LLC | Nuclear Medicine | 630 Broad St, Carlstadt, NJ 07072-1169 | 2011-04-06 |
| Street Address |
631 GRAND STREET SUITE 1-1 |
| City | JERSEY CITY |
| State | NJ |
| Zip Code | 07304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902104573 | Jersey City Radiation Therapy LLC | Radiology | 631 Grand Street, Suite 1-1, Jersey City, NJ 07304 | 2011-03-07 |
| 1871885814 | Urology Specialty Care Pa | Radiology | 631 Grand Street, Suite 1-1, Jersey City, NJ 07304-3417 | 2011-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790324085 | Marlon Q Lopez | Physical Therapist | 438 West Avenue, Virginia Cor Ege, Jersey, NJ 07304 | 2020-01-03 |
| 1033621842 | Dipty Mali | Physical Therapist | 520 Bergen Avenue, Jersey City, NJ 07304 | 2017-11-02 |
| 1861914434 | Eulalia Rivera | Licensed Practical Nurse | 140 Boyd Ave, Jersey City, NJ 07304 | 2017-07-14 |
| 1336509223 | Hyojin Park | Student in an Organized Health Care Education/Training Program | 935 Garfield Avenue, Metropolitan Family Health Network, Inc. - Jersey City, Jersey City, NJ 07304 | 2016-03-04 |
| 1962878413 | Hudson Milestones | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13-15 Miller Street, Jersey City, NJ 07304 | 2015-08-19 |
| 1336515881 | Hudson Milestones | Day Training, Developmentally Disabled Services | 355 Clendenny Avenue, Jersey City, NJ 07304 | 2015-08-19 |
| 1922482025 | Cosmo Pharmacy LLC | Pharmacy | 402 Pacific Avenue, Jersey City, NJ 07304 | 2015-07-17 |
| 1033513171 | Walgreens | Health Maintenance Organization | 2395 John Kennedy Blvd, Jersey City, NJ 07304 | 2014-10-17 |
| 1427460138 | Medical Claims Adjustment Pros | Spec/Tech, Health Info | 79 Jewett Avenue Ste 2, Jersey City, NJ 07304 | 2014-05-29 |
| 1801133103 | Hoboken Holistic Physical Therapy and Sports Medicine LLC | Acupuncturist | 701 State Route 440 Suite 21, Jersey City, NJ 07304 | 2013-01-08 |
| Find all providers in zip 07304 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902104573 | Jersey City Radiation Therapy LLC | Radiology | 631 Grand Street, Suite 1-1, Jersey City, NJ 07304 | 2011-03-07 |
| 1871885814 | Urology Specialty Care Pa | Radiology | 631 Grand Street, Suite 1-1, Jersey City, NJ 07304-3417 | 2011-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255856423 | Lourdes Medical Associates, Pa | Radiology | 220 Sunset Rd Ste 4, Willingboro, NJ 08046-1126 | 2017-08-09 |
| 1851788772 | Byung Han Rhieu | Radiology | 33 Overlook Rd Ste L05, Summit, NJ 07901-3561 | 2015-04-17 |
| 1801206776 | Gary Eastwick | Radiology | Two Cooper Plaza, 400 Haddon Ave, Camden, NJ 08103 | 2014-05-01 |
| 1568882900 | Matthew Listo | Radiology | 900 Route 70 # 1a, Lakewood, NJ 08701-5940 | 2014-04-24 |
| 1558641126 | Princeton Procure Management, LLC | Radiology | 103 Cedar Grove Ln, Somerset, NJ 08873-4717 | 2011-08-26 |
| 1972807824 | Hackensack Radiation Therapy LLC | Radiology | 20 Woodridge Ave, Hackensack, NJ 07601-6013 | 2011-01-07 |
| 1477865426 | Megan A. Mezera | Radiology | Two Cooper Plaza 400 Haddon Ave, Camden, NJ 08103 | 2010-07-07 |
| 1609008333 | Alina Hirsh | Radiology | 2090 Springdale Road, Suite B, Cherry Hill, NJ 08003 | 2009-08-13 |
| 1225278518 | Susan M Weissman | Radiology | 22 Stratford Dr, Livingston, NJ 07039-5140 | 2009-02-25 |
| 1760639918 | Rekha D. Iyengar | Radiology | 9 Chelsea Dr, Livingston, NJ 07039-3424 | 2008-08-19 |
| Find all providers with the same taxonomy | ||||
| City | JERSEY CITY |
| Zip Code | 07304 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.