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General NPI Number Information
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NPI Number | 1497618904
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Entity Type | Organization
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Legal Business Name | OAKSHORE PSYCHIATRY LLC
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 185 ROUTE 36 STE 120
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1339
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Country | US
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Telephone | 856-439-4330
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Fax |
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Provider Business Mailing Address
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Address Line | 185 ROUTE 36 STE 120
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1339
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Country | US
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Telephone | 856-439-4330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACLYN DIETZOLD
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Credential | MD
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Telephone | 856-439-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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