| Kevin T Custis M D P C | |
|
887 E New York Ave Brooklyn NY 11203-1309 | |
| (718) 778-0069 | |
| (718) 778-0035 |
| Full Name | Kevin T Custis M D P C |
|---|---|
| Speciality | Family Medicine |
| Location | 887 E New York Ave, Brooklyn, New York |
| Authorized Official Name and Position | Kevin Tyrone Custis (CEO) |
| Authorized Official Contact | 7183636675 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin T Custis M D P C 63 Meadow Lark Ln Belle Mead NJ 08502-4929 Ph: (908) 431-7707 | Kevin T Custis M D P C 887 E New York Ave Brooklyn NY 11203-1309 Ph: (718) 778-0069 |
| NPI Number | 1376511881 |
|---|---|
| Provider Enumeration Date | 03/09/2006 |
| Last Update Date | 08/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376511881 | NPI | - | NPPES |
| 7505055 | Other | NY | AETNA US HEALTHCARE |
| 40 V182 | Other | NY | EMPIRE BLUE CROSS BLUE SHIELD |
| 6016214 | Other | NY | GHI |
| 01976654 | Medicaid | NY | |
| 40V183 | Other | NY | EMPIRE BLUE CROSS BLUE SHIELD |
| P2215900 | Other | NY | OXFORDN HEALTH PLANS |
| 211807 | Other | NY | HIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 211807 (New York) | Primary |
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