SOVEREIGN MEDICAL GROUP LLC (NPI# 1205125655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205125655 |
| Entity Type | Organization |
| Organization Name | SOVEREIGN MEDICAL GROUP LLC |
| Other Organization Name | UROLOGY SPECIALTLY CARE PA |
| Practice Address |
15-01 Broadway Suite 1 & 3 Fair Lawn NJ 07410 |
| Mailing Address |
85 Harristown Rd Fl 2 Glen Rock NJ 07452-3329 |
| Practice Telephone | 2017914544 |
| Practice Fax Number | 2017946970 |
| Mailing Telephone | 2018558446 |
| Mailing Fax Number | 2014440350 |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2018-05-31 |
| Authorized Official Name | JOHN H HAJJAR (OWNER) |
| Authorized Official Telephone | 2017914544 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | SOVEREIGN MEDICAL GROUP LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207ZC0006X |
Pathology Specialization: Clinical Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2088P0231X |
Urology Specialization: Pediatric Urology |
Allopathic & Osteopathic Physicians | ||
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 7586205 | 05 |
| Other Name | Type Code |
|---|---|
| Urology Specialtly Care PA | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15-01 Broadway, Suite 1 & 3, Fair Lawn, NJ 074106003 | 2017914544 | 2017946970 |
| 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 |
| 1114216660 | Sovereign Medical Group LLC | Radiology | 631 Grand Street, Suite 1-1, Jersey City, NJ 07304 | 2011-04-06 |
| 1841589298 | Sovereign Medical Group LLC | Nuclear Medicine | 630 Broad St, Carlstadt, NJ 07072-1169 | 2011-04-06 |
| Street Address |
15-01 BROADWAY SUITE 1 & 3 |
| City | FAIR LAWN |
| State | NJ |
| Zip Code | 07410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205813391 | Ramesh C Gupta | Internal Medicine | 15-01 Broadway, Suite 28, Fair Lawn, NJ 07410-6003 | 2005-12-29 |
| 1649752221 | Emelita D Paragas | Physical Therapist | 15-01 Broadway, Suite 30a, Fair Lawn, NJ 07410 | 2018-08-30 |
| 1154869733 | Beena Patel | Physical Therapist | 15-01 Broadway, Suite 30a, Fair Lawn, NJ 07410 | 2017-02-03 |
| 1952773392 | Fairlawn Behavioral Associates | Social Worker | 15-01 Broadway, Suite 10b, Fair Lawn, NJ 07410-6003 | 2015-10-26 |
| 1861876419 | Fairlawn Behavioral Associates LLC | Psychologist | 15-01 Broadway, Suite# 10b, Fair Lawn, NJ 07410-6003 | 2015-07-14 |
| 1720400476 | Donald H Kutner Do LLC | Anesthesiology | 15-01 Broadway, Suite 34, Fair Lawn, NJ 07410-6003 | 2014-01-15 |
| 1023350238 | Imedical Associates, LLC | Internal Medicine | 15-01 Broadway, Suite 32, Fair Lawn, NJ 07410-6003 | 2013-03-26 |
| 1922300326 | Ma Grace Espinas | Physical Therapist | 15-01 Broadway, Suite 30a, Fair Lawn, NJ 07410-6003 | 2010-11-17 |
| 1750607008 | Rachel Carrie Mandel | Dentist | 15-01 Broadway, Fair Lawn, NJ 07410-6003 | 2010-04-12 |
| 1407184914 | Barry Jansen PC | Podiatrist | 15-01 Broadway, Suite 11, Fair Lawn, NJ 07410-6003 | 2009-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669093316 | Sheila Robinson-kiss LLC | Counselor | 0-178 Tunbridge Road, Fair Lawn, NJ 07410 | 2020-05-05 |
| 1750902813 | Pine Group LLC | Point of Service | 0-39 Pine Ave, Fair Lawn, NJ 07410 | 2020-04-29 |
| 1073133153 | Maria Jidriska Myers | Nurse Practitioner | 23-00 Nj-208, Fair Lawn, NJ 07410 | 2020-04-20 |
| 1508350869 | Jill Marie Deperi | Counselor | 22-08 Route 208 South, Fair Lawn, NJ 07410 | 2018-06-20 |
| 1952895419 | Laurel Olson | Counselor | Care Plus Nj Children and Family Services, 17-07 Romaine Street, Fair Lawn, NJ 07410 | 2018-06-19 |
| 1851896583 | Janelle Frazier | Social Worker | Care Plus New Jersey, 17-07 Romaine St, Fair Lawn, NJ 07410 | 2018-03-26 |
| 1457876260 | Daniella Suric | Behavioral Analyst | 2-08 Morlot Avenue, Fair Lawn, NJ 07410 | 2017-08-14 |
| 1912453549 | Marcia Gurfield | Social Worker | 33-03 Ryan Road, Fair Lawn, NJ 07410 | 2016-09-01 |
| 1417330721 | The Arc of Bergen and Passaic Counties, Inc | Day Training, Developmentally Disabled Services | 17-03a Broadway, Fair Lawn, NJ 07410 | 2015-07-06 |
| 1275914228 | Julius Iratagotia | Occupational Therapist | 0-53 26th St, Fair Lawn, NJ 07410 | 2015-06-16 |
| Find all providers in zip 07410 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104894435 | John H. Hajjar | Urology | 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410-6003 | 2006-03-11 |
| 1174591762 | Andranik Howhannesian | Urology | 14-01 Broadway Ste 3, Fair Lawn, NJ 07410-2008 | 2006-03-09 |
| 1487883591 | Stephen Gordon Cohen | Urology | 1501 Broadway, Fair Lawn, NJ 07410-6003 | 2009-07-09 |
| 1679724694 | Keith Alan Christiansen | Urology | 14-01 Broadway Ste 3, Fair Lawn, NJ 07410-2008 | 2008-10-08 |
| 1740249143 | Glenn A. Gmyrek | Urology | 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 | 2006-03-23 |
| 1124087523 | Clifford B Bleustein | Urology | 15-01 Broadway, Rt 4 West, Suites 1 & 3, Fair Lawn, NJ 07410 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144834532 | Advanced Urology Associates Enterprises | Urology | 525 Jack Martin Blvd Ste 304, Brick, NJ 08724-7737 | 2020-09-02 |
| 1922646132 | Pierre Mendoza Md LLC | Urology | 9 Mule Rd Ste 5, Toms River, NJ 08755-5052 | 2019-12-18 |
| 1215579297 | Jsmk Urology PC | Urology | 140 Sylvan Ave Ste 202, Englewood Cliffs, NJ 07632-2559 | 2019-10-11 |
| 1942854724 | Braga Urologic LLC | Urology | 106 Court House South Dennis Rd Ste 201, Cape May Court House, NJ 08210-2126 | 2019-07-30 |
| 1043863848 | Pedro R Paulino | Urology | 78 Highland St, Paterson, NJ 07524-1906 | 2019-07-20 |
| 1730683905 | Urgent Specialists Nj LLC | Urology | 185 Hudson St, Jersey City, NJ 07311-1209 | 2018-03-21 |
| 1861942393 | A E Feldman LLC | Urology | 125 Matthews Dr, Bedminster, NJ 07921-2624 | 2016-10-07 |
| 1033584057 | Howard Leitner & Perlmutter Urologic Associates | Urology | 2401 State Route 35, Manasquan, NJ 08736-1158 | 2015-12-02 |
| 1124499041 | Hunterdon Specialty Care, PC | Urology | 121 Highway 31, Suite 1200, Flemington, NJ 08822-5744 | 2015-10-19 |
| 1881089654 | Chirag G Gordhan | Urology | 2401 E Evesham Rd Ste F, Voorhees, NJ 08043-9590 | 2015-03-30 |
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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.