Healthcare Provider Details

I. General information

NPI: 1245952738
Provider Name (Legal Business Name): BESPOKE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GLACIER DR
BERLIN NJ
08009-9377
US

IV. Provider business mailing address

57 GLACIER DR
BERLIN NJ
08009-9377
US

V. Phone/Fax

Practice location:
  • Phone: 732-284-4422
  • Fax: 732-374-4836
Mailing address:
  • Phone: 732-614-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIAL KHAN
Title or Position: BUSINESS OWNER
Credential: DPT
Phone: 848-342-9986