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Organization
KEVIN T CUSTIS M D P C
Active
Organization
KEVIN T CUSTIS M D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN TYRONE CUSTIS M D (CEO)
(718) 363-6675
Entity
Organization
Contact information
Practice address
887 E NEW YORK AVE, BROOKLYN, NY 11203-1309
(718) 778-0069
(718) 778-0035
Mailing address
63 MEADOW LARK LN, BELLE MEAD, NJ 08502-4929
(908) 431-7707
(908) 431-9329
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
211807
NY
Other
Enumeration date
03/09/2006
Last updated
08/06/2015
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