NPIMap

Organization Active NPI

Sovereign Medical Group LLC

  • Radiation Oncology Physician
  • Jersey City, NJ
National Provider Identifier
1114216660
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
SOVEREIGN MEDICAL GROUP LLC
Practice address
631 Grand Street
Suite 1-1
Jersey City, NJ 07304
Phone
(201) 880-7580
Fax
(201) 880-7585
NPI assigned
Apr 6, 2011
Organization subpart
Yes
Parent organization
SOVEREIGN MEDICAL GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald Vardaro
Title
Administrative Director
Phone
(201) 880-7580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

631 Grand Street
Suite 1-1
Jersey City, NJ 07304

Mailing address

631 Grand Street
Suite 1-1
Jersey City, NJ 07304
Phone (201) 880-7580

Other names 1

  • Jersey City Radiation Therapy LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sovereign Medical Group LLC4 organizations share this tax ID, including this one
Part of
Sovereign Medical Group LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1114216660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 GRAND STREET",
            "address_2": "SUITE 1-1",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07304",
            "telephone_number": "201-880-7580",
            "fax_number": "201-880-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 GRAND STREET",
            "address_2": "SUITE 1-1",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07304",
            "telephone_number": "201-880-7580",
            "fax_number": "201-880-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOVEREIGN MEDICAL GROUP LLC",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "VARDARO",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "201-880-7580"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey City Radiation Therapy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.