Healthcare Provider Details

I. General information

NPI: 1649388133
Provider Name (Legal Business Name): JACQUELINE VIERHEILIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OCEAN AVE APT 12A
BELMAR NJ
07719-2059
US

IV. Provider business mailing address

PO BOX 1
MIDLAND PARK NJ
07432-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-6669
  • Fax:
Mailing address:
  • Phone: 201-445-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA62983
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-50139
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01094160A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberV4078
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number160437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: