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Organization
NJ-BROOKLYN MEDICAL ASSOCIATES, LLC
Active
Organization
NJ-BROOKLYN MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN CUSTIS M.D. (SOLE PROPRIETOR)
(732) 264-2224
Entity
Organization
Contact information
Practice address
39 W FRONT ST, KEYPORT, NJ 07735-1209
(732) 264-2224
(732) 264-4291
Mailing address
39 WEST FRONT ST., KEYPORT, NJ 07735-1209
(732) 264-2224
(732) 264-4291
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08719200
NJ
Other
Enumeration date
08/07/2012
Last updated
08/26/2013
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