| Sovereign Medical Group Llc | |
|
680 Kinderkamack Rd 3rd Floor Suite 300 Oradell NJ 07649-1600 | |
| (201) 621-0858 | |
| (201) 444-0350 |
| Full Name | Sovereign Medical Group Llc |
|---|---|
| Speciality | Urology |
| Location | 680 Kinderkamack Rd, Oradell, New Jersey |
| Authorized Official Name and Position | John H. Hajjar (CEO) |
| Authorized Official Contact | 2018341100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sovereign Medical Group Llc 680 Kinderkamack Rd Suite 300 3rd Floor Oradell NJ 07649-1600 Ph: (201) 834-1100 | Sovereign Medical Group Llc 680 Kinderkamack Rd 3rd Floor Suite 300 Oradell NJ 07649-1600 Ph: (201) 621-0858 |
| NPI Number | 1710282082 |
|---|---|
| Provider Enumeration Date | 01/18/2011 |
| Last Update Date | 09/12/2023 |
| Medicare PECOS PAC ID | 1456535392 |
|---|---|
| Medicare Enrollment ID | O20110418000519 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710282082 | NPI | - | NPPES |
| Provider Name | John J Hosay |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1255432886 PECOS PAC ID: 7214830306 Enrollment ID: I20040128000053 |
| Provider Name | Rena E Levykh-chase |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215085360 PECOS PAC ID: 4183512197 Enrollment ID: I20040310000135 |
| Provider Name | Elliot G Steigman |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1407923584 PECOS PAC ID: 5294729810 Enrollment ID: I20040414001097 |
| Provider Name | Brendan P Sullivan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174521140 PECOS PAC ID: 9335135458 Enrollment ID: I20040423000481 |
| Provider Name | Karim I Karim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417917717 PECOS PAC ID: 3678569696 Enrollment ID: I20040423000576 |
| Provider Name | Sam H Hessami |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831167162 PECOS PAC ID: 5890781645 Enrollment ID: I20040426000465 |
| Provider Name | Vasiliki Saitas |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1427105428 PECOS PAC ID: 2264420447 Enrollment ID: I20040505000948 |
| Provider Name | Louis F Perdomo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1669547402 PECOS PAC ID: 9739167040 Enrollment ID: I20040713000377 |
| Provider Name | Charles F Asta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245314806 PECOS PAC ID: 5890755482 Enrollment ID: I20041018000990 |
| Provider Name | Henry M Baquiran |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093863508 PECOS PAC ID: 7214991942 Enrollment ID: I20041112000861 |
| Provider Name | Gopal R Desai |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1104870450 PECOS PAC ID: 0749251007 Enrollment ID: I20041213000116 |
| Provider Name | Stephen N Zoretic |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1295703890 PECOS PAC ID: 2961450192 Enrollment ID: I20050105000093 |
| Provider Name | Scott A Goler |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053347385 PECOS PAC ID: 1456390574 Enrollment ID: I20050428000385 |
| Provider Name | Nathaniel J Holmes |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801868187 PECOS PAC ID: 5991747693 Enrollment ID: I20050524000058 |
| Provider Name | Steven D Gillon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285668376 PECOS PAC ID: 7012952914 Enrollment ID: I20050622000045 |
| Provider Name | Morteza Shahamat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154429959 PECOS PAC ID: 5395780241 Enrollment ID: I20050622000427 |
| Provider Name | Alan Shaiman |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1619065059 PECOS PAC ID: 5991790982 Enrollment ID: I20050713000097 |
| Provider Name | Robert Leon Goodman |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1649217779 PECOS PAC ID: 0840227088 Enrollment ID: I20050720000215 |
| Provider Name | Carolyn J Mudry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427013937 PECOS PAC ID: 7810921939 Enrollment ID: I20050923000042 |
| Provider Name | David J Nitti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750499158 PECOS PAC ID: 5092740100 Enrollment ID: I20050928000125 |
| Provider Name | Raffi E Agopian |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1770584583 PECOS PAC ID: 7911923792 Enrollment ID: I20051020000755 |
| Provider Name | Daniel James Wilkin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922092121 PECOS PAC ID: 8921063793 Enrollment ID: I20051108000119 |
| Provider Name | Alyssa Becker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023187143 PECOS PAC ID: 2062433204 Enrollment ID: I20051215000089 |
| Provider Name | Jay S Rosen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1477521706 PECOS PAC ID: 8527082684 Enrollment ID: I20060117000732 |
| Provider Name | Lisa Ferraro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659302925 PECOS PAC ID: 0345264370 Enrollment ID: I20060118000142 |
| Provider Name | Nilay Shah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154372621 PECOS PAC ID: 5890704811 Enrollment ID: I20070816000577 |
| Provider Name | Samuel Kuangzong Chen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1508891284 PECOS PAC ID: 1456446327 Enrollment ID: I20071008000170 |
| Provider Name | Alexander Biener |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1760671416 PECOS PAC ID: 5597843490 Enrollment ID: I20080417000314 |
| Provider Name | Joel Abramowitz |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1356429377 PECOS PAC ID: 1153490552 Enrollment ID: I20080527000000 |
| Provider Name | Linda Diliberto |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1295996726 PECOS PAC ID: 2163569849 Enrollment ID: I20091029000152 |
| Provider Name | Mark J Decker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023002862 PECOS PAC ID: 7315938420 Enrollment ID: I20091103000710 |
| Provider Name | Dov Gorshein |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1396897732 PECOS PAC ID: 9032259064 Enrollment ID: I20091222000572 |
| Provider Name | Laurence M Milgrim |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1255307989 PECOS PAC ID: 8325103062 Enrollment ID: I20100225000454 |
| Provider Name | Alan J Shienbaum |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1811967904 PECOS PAC ID: 1557406568 Enrollment ID: I20100302000548 |
| Provider Name | Premetesh Chattoo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255395083 PECOS PAC ID: 2466419775 Enrollment ID: I20100602000479 |
| Provider Name | Morris A Tilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851363964 PECOS PAC ID: 9335273556 Enrollment ID: I20100810000561 |
| Provider Name | Nina Safa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942357595 PECOS PAC ID: 8022046614 Enrollment ID: I20100917000974 |
| Provider Name | Andranik Howhannesian |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1174591762 PECOS PAC ID: 8820124621 Enrollment ID: I20100920000140 |
| Provider Name | Jason A Shatkin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1669529202 PECOS PAC ID: 8325076912 Enrollment ID: I20100920000153 |
| Provider Name | Glenn A Gmyrek |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1740249143 PECOS PAC ID: 1153485537 Enrollment ID: I20100920000656 |
| Provider Name | John H Hajjar |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1104894435 PECOS PAC ID: 2769388149 Enrollment ID: I20100921000051 |
| Provider Name | Harry Katz |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1508857814 PECOS PAC ID: 0941242796 Enrollment ID: I20101122001022 |
| Provider Name | Suneel Kumar Basra |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1447575691 PECOS PAC ID: 2466631254 Enrollment ID: I20110126000145 |
| Provider Name | Joseph N Grizzanti |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1932107554 PECOS PAC ID: 7416144662 Enrollment ID: I20110309000128 |
| Provider Name | Jay M Kashkin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235128497 PECOS PAC ID: 6800070400 Enrollment ID: I20110406000110 |
| Provider Name | Albert O Kwon |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1225298722 PECOS PAC ID: 4082892286 Enrollment ID: I20110616000490 |
| Provider Name | Elliot L Shulman |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1023037058 PECOS PAC ID: 9032397963 Enrollment ID: I20110624000143 |
| Provider Name | Keith A Christiansen |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1679724694 PECOS PAC ID: 5395917488 Enrollment ID: I20111014000203 |
| Provider Name | Henry Slomowitz |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1437243730 PECOS PAC ID: 0143432179 Enrollment ID: I20120110000269 |
| Provider Name | Jessica W Blume |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1295938579 PECOS PAC ID: 3971679416 Enrollment ID: I20120720000184 |
| Provider Name | Rory A Ulloque |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407127343 PECOS PAC ID: 7517113749 Enrollment ID: I20120803000432 |
| Provider Name | Yaser S El-gazzar |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033416995 PECOS PAC ID: 8729256375 Enrollment ID: I20121211000167 |
| Provider Name | Timothy James Henderson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326005307 PECOS PAC ID: 1355374760 Enrollment ID: I20121214000003 |
| Provider Name | Thomas J Negri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033487152 PECOS PAC ID: 6002060258 Enrollment ID: I20130218000008 |
| Provider Name | Nicole M Cofini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427481993 PECOS PAC ID: 6406080076 Enrollment ID: I20131015000531 |
| Provider Name | Ravi Diwan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376792382 PECOS PAC ID: 0749423002 Enrollment ID: I20131125000420 |
| Provider Name | Raffaella L Kalishman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255610507 PECOS PAC ID: 5395961759 Enrollment ID: I20140722000741 |
| Provider Name | Benjamin D Acker |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1104057439 PECOS PAC ID: 7315165099 Enrollment ID: I20140821000120 |
| Provider Name | Deepan N Patel |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1912171372 PECOS PAC ID: 1951529049 Enrollment ID: I20140903000841 |
| Provider Name | Ahmed Suhail Hadi |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1831490614 PECOS PAC ID: 8325268063 Enrollment ID: I20141001001752 |
| Provider Name | Homam Badri |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1093000465 PECOS PAC ID: 1557583358 Enrollment ID: I20141111001917 |
| Provider Name | Shai Shoshani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609195726 PECOS PAC ID: 2163743469 Enrollment ID: I20150611000365 |
| Provider Name | Stephan Dorkhom |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1578872776 PECOS PAC ID: 1052505237 Enrollment ID: I20150728005461 |
| Provider Name | Joanne Zhung |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1619296092 PECOS PAC ID: 2668786070 Enrollment ID: I20150729009028 |
| Provider Name | Louis G Petcu |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1427088376 PECOS PAC ID: 0840225603 Enrollment ID: I20151019000085 |
| Provider Name | Diana L Fibison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932479706 PECOS PAC ID: 0143525881 Enrollment ID: I20160218000527 |
| Provider Name | Jeanine Chiaffarano |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164810156 PECOS PAC ID: 4789952870 Enrollment ID: I20170614000168 |
| Provider Name | Daniel J Waltuch |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386059558 PECOS PAC ID: 0941579759 Enrollment ID: I20170711002369 |
| Provider Name | Richard Maggio |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1205939998 PECOS PAC ID: 7214927417 Enrollment ID: I20170804003070 |
| Provider Name | Diana V Araque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518493642 PECOS PAC ID: 0446522171 Enrollment ID: I20170816000040 |
| Provider Name | Victor Ortiz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568692051 PECOS PAC ID: 7012218357 Enrollment ID: I20171003004666 |
| Provider Name | Elizabeth A Drehwing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093192890 PECOS PAC ID: 2264723832 Enrollment ID: I20171030001296 |
| Provider Name | Cassandra Isca Val |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174064349 PECOS PAC ID: 4981972288 Enrollment ID: I20171108001854 |
| Provider Name | Daniel J Arthur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649783010 PECOS PAC ID: 2062773195 Enrollment ID: I20180306000152 |
| Provider Name | Jennifer K Porco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154767903 PECOS PAC ID: 5597056168 Enrollment ID: I20180515002552 |
| Provider Name | Karen M Bellapianta |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1447407960 PECOS PAC ID: 0345424156 Enrollment ID: I20190131000027 |
| Provider Name | Kenneth Hennrick |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1427374057 PECOS PAC ID: 7113230269 Enrollment ID: I20200511000174 |
| Provider Name | Christina Robinson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1669950838 PECOS PAC ID: 5294166781 Enrollment ID: I20200518001479 |
| Provider Name | Jamie Petkovic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205425204 PECOS PAC ID: 8123432267 Enrollment ID: I20210201000510 |
| Provider Name | Ryan M Cristelli |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1356811939 PECOS PAC ID: 5092116830 Enrollment ID: I20220307000242 |
| Provider Name | Corale Naor |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1528725538 PECOS PAC ID: 3577931435 Enrollment ID: I20221126000153 |
| Provider Name | Michelle Mirasgeldi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306545512 PECOS PAC ID: 5597120246 Enrollment ID: I20230502001242 |
| Provider Name | Adriana Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225735210 PECOS PAC ID: 5698132793 Enrollment ID: I20230606000218 |
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