Active NPI
Sovereign Medical Group LLC
Doing business as New Jersey Institute of Radiology PC
- Diagnostic Radiology Physician
- Carlstadt, NJ
National Provider Identifier
1841589298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- SOVEREIGN MEDICAL GROUP LLC
- Doing business as
- New Jersey Institute of Radiology PC
- Practice address
- 630 Broad St
Carlstadt, NJ 07072-1169 - Phone
- (201) 372-1020
- Fax
- (201) 372-1028
- NPI assigned
- Apr 6, 2011
- Last updated
- Jun 9, 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
- Ceo
- Phone
- (201) 791-4544
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Cardiology Physician | 207UN0901X | NU | ||
| Nuclear Imaging & Therapy Physician | 207UN0902X | NU | ||
| Body Imaging Physician | 2085B0100X | NU | ||
| Neuroradiology Physician | 2085N0700X | NU | ||
| Pediatric Radiology Physician | 2085P0229X | NU | ||
| Diagnostic Radiology Physician | 2085R0202X | NU | Primary | |
| Vascular & Interventional Radiology Physician | 2085R0204X | NU | ||
| Diagnostic Ultrasound Physician | 2085U0001X | NU |
Addresses
Primary practice location
630 Broad St
Carlstadt, NJ 07072-1169
Mailing address
630 Broad St
Carlstadt, NJ 07072-1169
Phone (201) 372-1020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0133311 | Medicaid | NJ |
Other names 1
- New Jersey Institute of Radiology PC
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 Urology Specialtly Care PA
- Urology Physician
- Fair Lawn, NJ
- NPI 1205125655
-
dba Hackensack Radiation Therapy LLC
- Radiation Oncology Physician
- Hackensack, NJ
- NPI 1669761110
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": "1841589298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 BROAD ST",
"city": "CARLSTADT",
"state": "NJ",
"postal_code": "070721169",
"telephone_number": "201-372-1020",
"fax_number": "201-372-1028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 BROAD ST",
"city": "CARLSTADT",
"state": "NJ",
"postal_code": "070721169",
"telephone_number": "201-372-1020",
"fax_number": "201-372-1028"
}
],
"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": "HAJJAR",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "201-791-4544",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207UN0901X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Cardiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0133311",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "New Jersey Institute of Radiology PC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Carlstadt, NJ
- Maria Helena Ruszkiewicz
- Kerolos Samy, RPH
- Joseph Smolinski, LCSW
- Sovereign Health Imaging, LLC
- Sovereign Health Imaging, LLC
- Sovereign Medical Group, LLC
- Sperling Ultrasound Consultants PC
- Stop and Shop Supermarket Co LLC (Stop and Shop Pharmacy 831)
- Surgicare Surgical Associates of Carlstadt, LLC
- Elzbieta Szymanowska
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.