Healthcare Provider Details

I. General information

NPI: 1336756758
Provider Name (Legal Business Name): BESPOKE TREATMENTS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MADISON AVE SUITE 1801
NEW YORK NY
10017-6404
US

IV. Provider business mailing address

295 MADISON AVE SUITE 1801
NEW YORK NY
10017-6404
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7427
  • Fax: 646-358-3443
Mailing address:
  • Phone: 646-596-7427
  • Fax: 646-358-3443

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: MATTHEW GUSKIN
Title or Position: DIRECTOR OF BILLING/COLLECTIONS
Credential:
Phone: 646-596-7427