Provider Demographics
NPI:1649388133
Name:VIERHEILIG, JACQUELINE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VIERHEILIG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-0001
Mailing Address - Country:US
Mailing Address - Phone:201-445-6669
Mailing Address - Fax:
Practice Address - Street 1:5 OCEAN AVE APT 12A
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2059
Practice Address - Country:US
Practice Address - Phone:201-445-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-50139207RI0200X
IN01094160A207RI0200X
NJMA62983207RI0200X
TXV4078207RI0200X
OH160437207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6927904Medicaid
NJ6927904Medicaid
NJ892003Medicare ID - Type Unspecified