| Doctor Name: | DR. BENNO GEORGE ROESCH |
| NPI Number: | 1700034592 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 25MA07669900 |
| Business Practice Address: | 241 Main St Hackensack, NJ - 076015715 |
| Business Phone Number: | 2016780288 |
| Business Fax Number: | |
| Mailing Address: | 581 Fletcher Ave, ORADELL |
| State: | NJ |
| Postal Code: | 076492501 |
| Phone Number: | 2012651842 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 09/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 25MA07669900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |