Provider Demographics
NPI:1629380449
Name:SOVEREIGN MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:SOVEREIGN MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-277-2121
Mailing Address - Street 1:420 JERICHO TPKE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1344
Mailing Address - Country:US
Mailing Address - Phone:516-277-2121
Mailing Address - Fax:516-277-2122
Practice Address - Street 1:420 JERICHO TPKE
Practice Address - Street 2:SUITE 212
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1344
Practice Address - Country:US
Practice Address - Phone:516-277-2121
Practice Address - Fax:516-277-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1760162086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty