# KEVIN T CUSTIS M D P C

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

## Provider details

- **NPI number:** 1376511881
- **Authorized official:** DR. KEVIN TYRONE CUSTIS M D (CEO)
- **Authorized official phone:** (718) 363-6675

## Contact information

- **Practice address:** 887 E NEW YORK AVE, BROOKLYN, NY 11203-1309
- **Practice address phone:** (718) 778-0069
- **Practice address fax:** (718) 778-0035
- **Mailing address:** 63 MEADOW LARK LN, BELLE MEAD, NJ 08502-4929
- **Mailing address phone:** (908) 431-7707
- **Mailing address fax:** (908) 431-9329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 211807 | NY | Yes |

## Other

- **Enumeration date:** 03/09/2006
- **Last updated:** 08/06/2015