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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NJ | 0256277 | 05 |
Other Name | Type Code |
---|---|
Hackensack 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 |
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 |
Street Address |
20 WOODRIDGE AVE |
City | HACKENSACK |
State | NJ |
Zip Code | 07601-6013 |
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 |
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 |
Find all providers in zip 07601 |
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 |
---|---|---|---|---|
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 |
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 |
Find all providers with the same taxonomy |
City | HACKENSACK |
Zip Code | 07601 |
Please comment or provide details below to improve the information on SOVEREIGN MEDICAL GROUP LLC.
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.