Active NPI
Sovereign Medical Group LLC
Doing business as Urology Specialtly Care PA
- Urology Physician
- Fair Lawn, NJ
National Provider Identifier
1205125655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- SOVEREIGN MEDICAL GROUP LLC
- Doing business as
- Urology Specialtly Care PA
- Practice address
- 15-01 Broadway
Suite 1 & 3
Fair Lawn, NJ 07410 - Phone
- (201) 791-4544
- Fax
- (201) 794-6970
- NPI assigned
- Apr 6, 2011
- Organization subpart
- Yes
- Parent organization
- SOVEREIGN MEDICAL GROUP LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John H Hajjar, MD
- Title
- Owner
- Phone
- (201) 791-4544
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Clinical Pathology Physician | 207ZC0006X | |||
| Radiation Oncology Physician | 2085R0001X | |||
| Diagnostic Radiology Physician | 2085R0202X | |||
| Urology Physician | 208800000X | Primary | ||
| Pediatric Urology Physician | 2088P0231X |
Addresses
Primary practice location
15-01 Broadway
Suite 1 & 3
Fair Lawn, NJ 07410
Mailing address
85 Harristown Rd FL 2
Glen Rock, NJ 07452-3329
Phone (201) 855-8446
Other practice location 1
15-01 Broadway
Suite 1 & 3
Fair Lawn, NJ 07410-6003
Phone (201) 791-4544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7586205 | Medicaid | NJ |
Other names 1
- Urology Specialtly Care PA
National Provider Directory
National Provider Directory- Tax ID family
- Sovereign Medical Group LLC
- 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.
-
dba Jersey City Radiation Therapy LLC
- Radiation Oncology Physician
- Jersey City, NJ
- NPI 1114216660
-
dba Hackensack Radiation Therapy LLC
- Radiation Oncology Physician
- Hackensack, NJ
- NPI 1669761110
-
dba New Jersey Institute of Radiology PC
- Diagnostic Radiology Physician
- Carlstadt, NJ
- NPI 1841589298
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": "1527724800000",
"number": "1205125655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 HARRISTOWN RD FL 2",
"city": "GLEN ROCK",
"state": "NJ",
"postal_code": "074523329",
"telephone_number": "201-855-8446",
"fax_number": "201-444-0350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15-01 BROADWAY",
"address_2": "SUITE 1 & 3",
"city": "FAIR LAWN",
"state": "NJ",
"postal_code": "07410",
"telephone_number": "201-791-4544",
"fax_number": "201-794-6970"
}
],
"practiceLocations": [
{
"address_1": "15-01 Broadway",
"address_2": "Suite 1 & 3",
"address_purpose": "LOCATION",
"city": "Fair Lawn",
"state": "NJ",
"postal_code": "074106003",
"country_code": "US",
"telephone_number": "201-791-4544",
"fax_number": "201-794-6970",
"country_name": "United States",
"address_type": "DOM"
}
],
"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": "2018-05-31",
"status": "A",
"authorized_official_last_name": "HAJJAR",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "201-791-4544",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207ZC0006X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pathology, Clinical Pathology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
},
{
"code": "2088P0231X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology, Pediatric Urology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7586205",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Urology Specialtly Care PA",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Urology Specialtly Care PA",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fair Lawn, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.