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Individual

DR. BETHANY DESROCHES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD, MS

Contact information

Practice address
360 ESSEX ST STE 403, HACKENSACK, NJ 07601-8566
(551) 996-2667
Mailing address
360 ESSEX ST STE 403, HACKENSACK, NJ 07601-8566
(551) 996-2667

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
BP10050157
TX
208800000X
Urology Physician
Primary
25MA10578000
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
25MA10578000
NJ MEDICAL LICENSE
NJ
01
BP10050157
TEXAS MEDICAL BOARD
TX
Enumeration date
05/12/2014
Last updated
07/02/2019
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