Organization Name: | SOVEREIGN MEDICAL GROUP LLC |
NPI Number: | 1841589298 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN H HAJJAR (CEO) |
Mailing Address: | 630 Broad St Carlstadt |
State: | NJ US |
Postal Code: | 070721169 |
Phone Number: | 2013721020 |
Fax Number: | 2013721028 |
NPI Enumeration Date: | 04/06/2011 |
NPI Last Update Date: | 06/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207UN0901X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Nuclear Medicine |
Taxonomy Specialization: | Nuclear Cardiology |
Taxonomy Definition: | A nuclear medicine physician who specializes in nuclear cardiology. |