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NPI Code Detail

MEDICARE: ASHLEY JACKLYN SO MD

MEDICARE: ASHLEY JACKLYN SO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician25MA12813600NJ

General Provider Information

NPI Number : 1124656095
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY JACKLYN SO MD
Provider Business Mailing Address
First Line : 300 2ND AVE
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-6303
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 2ND AVE
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-6395
Country : US
Telephone Number : 732-222-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 01/22/2026

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Directions to “ ASHLEY JACKLYN SO MD” Practice Location

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