Provider Demographics
NPI:1245952738
Name:BESPOKE REHAB
Entity type:Organization
Organization Name:BESPOKE REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:848-342-9986
Mailing Address - Street 1:57 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9377
Mailing Address - Country:US
Mailing Address - Phone:732-614-2779
Mailing Address - Fax:
Practice Address - Street 1:1806 NEW JERSEY 35
Practice Address - Street 2:206
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-284-4422
Practice Address - Fax:732-374-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy