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General NPI Number Information
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NPI Number | 1932571593
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Entity Type | Organization
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Legal Business Name | SOVEREIGN HEALTH IMAGING, LLC
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 630 BROAD ST LOWER LEVEL
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City | CARLSTADT
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State | NJ
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Zip | 07072-1169
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Country | US
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Telephone | 201-372-1020
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Fax | 201-372-1028
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Provider Business Mailing Address
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Address Line | 85 HARRISTOWN RD 2ND FLOOR
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City | GLEN ROCK
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State | NJ
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Zip | 07452-3329
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Country | US
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Telephone | 201-703-5500
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Fax | 201-703-5564
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Authorized Official
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Title or Position | OWNER
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Name | JOHN H. HAJJAR
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Credential | MD
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Telephone | 201-372-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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