# NJ-BROOKLYN MEDICAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316294572
- **Authorized official:** KEVIN CUSTIS M.D. (SOLE PROPRIETOR)
- **Authorized official phone:** (732) 264-2224

## Contact information

- **Practice address:** 39 W FRONT ST, KEYPORT, NJ 07735-1209
- **Practice address phone:** (732) 264-2224
- **Practice address fax:** (732) 264-4291
- **Mailing address:** 39 WEST FRONT ST., KEYPORT, NJ 07735-1209
- **Mailing address phone:** (732) 264-2224
- **Mailing address fax:** (732) 264-4291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA08719200 | NJ | Yes |

## Other

- **Enumeration date:** 08/07/2012
- **Last updated:** 08/26/2013