Healthcare Provider Details

I. General information

NPI: 1962317982
Provider Name (Legal Business Name): LIAM JOHN VIERBOOM MBBS BSC MHL FRACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 77TH ST APT 5A
NEW YORK NY
10075-2241
US

IV. Provider business mailing address

250 E 77TH ST APT 5A
NEW YORK NY
10075-2241
US

V. Phone/Fax

Practice location:
  • Phone: 646-265-4623
  • Fax:
Mailing address:
  • Phone: 646-265-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberP141964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: