New Jersey Travel Clinic, LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

25MA06298300 Issued in NJ

Legal business name

NEW JERSEY TRAVEL CLINIC, LLC

Practice address

205 Browertown Rd
Suite #202
Woodland Park, NJ 07424-2671

Phone

(201) 345-4550

NPI assigned

Jul 10, 2013

Last updated

Jul 10, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacqueline M. Vierheilig, M.D.

Title

Physician

Phone

(201) 345-4550

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1699116392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "074320001",
            "telephone_number": "201-345-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BROWERTOWN RD",
            "address_2": "SUITE #202",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074242671",
            "telephone_number": "201-345-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY TRAVEL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "VIERHEILIG",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "201-345-4550",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NJ",
            "license": "25MA06298300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Woodland Park, NJ by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.