SOVEREIGN MEDICAL GROUP LLC


Address: 20 Woodridge Ave, Hackensack, NJ 07601-6013
Phone: 2018807580

SOVEREIGN MEDICAL GROUP LLC (NPI# 1669761110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1669761110
Entity Type Organization
Organization Name SOVEREIGN MEDICAL GROUP LLC
Other Organization Name HACKENSACK RADIATION THERAPY LLC
Practice Address 20 Woodridge Ave
Hackensack
NJ 07601-6013
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 F VARDARO (ADMINISTRATIVE DIRECTOR)
Authorized Official Telephone 2018807580
Is Organization Subpart Y
Parent Organization Name SOVEREIGN MEDICAL GROUP LLC

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2085R0001X Radiology
Specialization: Radiation Oncology
Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NJ 0256277 05

Other Provider/Organization Names

Other Name Type Code
Hackensack Radiation Therapy LLC Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1710282082 Sovereign Medical Group LLC Radiology 85 Harristown Rd Fl 2, Glen Rock, NJ 07452-3329 2011-01-18
1205125655 Sovereign Medical Group LLC Internal Medicine 15-01 Broadway, Suite 1 & 3, Fair Lawn, NJ 07410 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

Office Location

Street Address 20 WOODRIDGE AVE
City HACKENSACK
State NJ
Zip Code 07601-6013

Providers in the same location

NPI Name Taxonomy Address Enumeration
1972807824 Hackensack Radiation Therapy LLC Radiology 20 Woodridge Ave, Hackensack, NJ 07601-6013 2011-01-07
1326330366 Urology Specialty Care Pa Radiology 20 Woodridge Ave, Hackensack, NJ 07601-6013 2011-05-10

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1750989414 Alpha Healthcare Staffing Firm, LLC Registered Nurse 194 Passaic Street, Hackensack, NJ 07601 2020-10-15
1396350120 Lower Limb Institute Podiatrist 211 Esses Street, Suite 405, Hackesack, NJ 07601 2020-09-09
1649825233 Rachel Korenblit Social Worker 235 Main St Ste 203, Hackensack, NJ 07601 2019-08-09
1740846567 Samantha Pirnat Counselor 426 Hudson Street, 2nd Floor, Hackensack, NJ 07601 2019-05-16
1881258499 Tara Lynn Smith Social Worker 160 South River Street, Hackensack, NJ 07601 2019-04-29
1922569318 Solomon Isakov Dentist 835 Prospect Ave, Suite 304, Hackensack, NJ 07601 2019-03-27
1114403409 Mildred Lopez Vasquez Home Health Aide 12 Rowland Avenue, Hackensack, NJ 07601 2018-07-19
1538656582 Zara Pharmacy LLC Pharmacy 57 Linden St, Hackensack, NJ 07601 2018-04-16
1447759048 Maryann Hom Social Worker 307 Prospect Avenue, 14e, Hackensack, NJ 07601 2018-02-08
1699274258 Kirsten Byrnes Psychologist Audrey Hepburn Children's House, Hackensack Umc, 12 Second St, Hackensack, NJ 07601 2018-02-08
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Taxonomy Information

Taxonomy Code 2085R0001X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Radiation Oncology

Taxonomy Definition

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

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1972807824 Hackensack Radiation Therapy LLC Radiology 20 Woodridge Ave, Hackensack, NJ 07601-6013 2011-01-07
1326330366 Urology Specialty Care Pa Radiology 20 Woodridge Ave, Hackensack, NJ 07601-6013 2011-05-10
1306010806 Brett Eric Lewis Radiology 92 2nd St, Hackensack, NJ 07601-2191 2008-04-15
1710940127 Anthony C Ingenito Radiology 92 2nd St, Hackensack, NJ 07601-2191 2006-04-07
1972565182 Glen Gejerman Radiology 92 2nd St, Hackensack, NJ 07601-2191 2006-04-04
1780645911 Loren Godfrey Radiology 92 2nd St, Hackensack, NJ 07601-2191 2006-03-29

Providers in the same taxonomy and state

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
1902104573 Jersey City Radiation Therapy LLC Radiology 631 Grand Street, Suite 1-1, Jersey City, NJ 07304 2011-03-07
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
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Competitor

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City HACKENSACK
Zip Code 07601

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Dataset Information

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.

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