31D2224194 CLIA NUMBER - SOVEREIGN MEDICAL GROUP, LLC

Laboratory Demographics

CLIA Number: 31D2224194

Facility Name: SOVEREIGN MEDICAL GROUP, LLC

Facility Address:
631 GRAND STREET SUITE 2-200
JERSEY CITY, NJ
ZIP 07304
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Facility Phone Number: 201 803-7401

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1669761110

Taxonomy: 2085R0001X - Radiology
A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.

CLIA Record

Field Name	Field Value
CLIA Number	31D2224194
LAB Type	Physician Office
Facility Name	SOVEREIGN MEDICAL GROUP, LLC
Street	631 GRAND STREET SUITE 2-200
City	JERSEY CITY
State	NJ
ZIP	07304
Phone	201 803-7401
CertificateType	2
CertificateEffectiveDate	4/5/2023
CertificateExpirationDate	4/4/2025
FacilityType	Compliance

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This page was last updated on: 4/23/2024