KEVIN T CUSTIS M D P C (NPI# 1376511881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376511881 |
| Entity Type | Organization |
| Organization Name | KEVIN T CUSTIS M D P C |
| Practice Address |
887 E New York Ave Brooklyn NY 11203-1309 |
| Mailing Address |
63 Meadow Lark Ln Belle Mead NJ 08502-4929 |
| Practice Telephone | 7187780069 |
| Practice Fax Number | 7187780035 |
| Mailing Telephone | 9084317707 |
| Mailing Fax Number | 9084319329 |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2015-08-06 |
| Authorized Official Name | DR. KEVIN TYRONE CUSTIS (CEO) |
| Authorized Official Telephone | 7183636675 |
| Authorized Official Credential | M D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 211807 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | HIP | 211807 | 01 |
| NY | AETNA US HEALTHCARE | 7505055 | 01 |
| NY | OXFORDN HEALTH PLANS | P2215900 | 01 |
| NY | EMPIRE BLUE CROSS BLUE SHIELD | 40V183 | 01 |
| NY | GHI | 6016214 | 01 |
| NY | 01976654 | 05 | |
| NY | EMPIRE BLUE CROSS BLUE SHIELD | 40 V182 | 01 |
| Street Address |
887 E NEW YORK AVE |
| City | BROOKLYN |
| State | NY |
| Zip Code | 11203-1309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861806051 | Rachel Minkin | Social Worker | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2014-06-16 |
| 1598102709 | Seneca Williams | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2013-05-29 |
| 1598049819 | Marly Brice | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2011-10-05 |
| 1922395391 | Zahavah Selinger | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2011-07-06 |
| 1215228796 | Elba Sette-camara | Social Worker | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2011-05-02 |
| 1962708115 | Rebecca Brum | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2011-02-07 |
| 1609177062 | Sofiya Sarukhanyan | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2010-11-16 |
| 1295040087 | Raku Coryne | Social Worker | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2010-08-17 |
| 1023341666 | Tessa Thomas Thompson | Social Worker | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2009-09-15 |
| 1417189861 | Ephram Goodman | Counselor | 887 E New York Ave, Brooklyn, NY 11203-1309 | 2009-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615747 | Winnie Ming Wong | Dance Therapist | 451 Clarkson Ave R Building, Idd/mh Unit, R5west, Brooklyn, NY 11203 | 2020-10-06 |
| 1174134803 | Jermiah Jonoah Jones | Social Worker | 307 E 54th St, 3, Brooklyn, NY 11203 | 2020-08-14 |
| 1780201566 | Jesvin Jeyapaulraj | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Suny Downstate, General Surgery Department, Brooklyn, NY 11203 | 2020-06-29 |
| 1881219731 | Natasha Thomas | Specialist | 140 East 52nd St Brooklyn, Apt 1r, Brooklyn, NY 11203 | 2020-06-16 |
| 1679197396 | Syed Hamza Bin Waqar | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Msc 50, Suny Downstate, Brooklyn, NY 11203 | 2020-05-29 |
| 1013536846 | Isaak Rubinov | Student in an Organized Health Care Education/Training Program | 91 E 39th St, Brooklyn, NY 11203 | 2020-04-12 |
| 1932733615 | Shade Celestine | Specialist | 293 East53rd Street, Brooklyn, NY 11203 | 2020-03-03 |
| 1023656147 | Shenez Brutus | Nurse Practitioner | Suny Downstate College of Nursing, 450 Clarkson Avenue, Brooklyn, NY 11203 | 2019-12-19 |
| 1215586425 | Terry-ann Lee | Registered Nurse | 440 East 45th Street, Kings, NY 11203 | 2019-09-10 |
| 1568023828 | Mmeyeneabasi David Omede | Student in an Organized Health Care Education/Training Program | 450 Clarkson Avenue, Suny Downstate Medical Center, Brooklyn, NY 11203 | 2019-06-26 |
| Find all providers in zip 11203 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639782972 | Home Physician Assistant Services PC | Family Medicine | 2119 E 15th St Ste B1, Brooklyn, NY 11229-4376 | 2020-08-26 |
| 1932719044 | Sophie Miro Fortier | Family Medicine | 70 Washington St Apt 7j, Brooklyn, NY 11201-1466 | 2020-08-04 |
| 1598380701 | Imaduddin Hashmi Md Pllc | Family Medicine | 527 Coney Island Ave, Brooklyn, NY 11218-3466 | 2020-06-12 |
| 1932723053 | Cherysh Foster | Family Medicine | 299 Malcolm X Blvd, Brooklyn, NY 11233-3996 | 2020-06-04 |
| 1497377246 | Central Brooklyn Physician Pllc | Family Medicine | 387 Linden Blvd Fl 1, Brooklyn, NY 11203-2823 | 2020-05-15 |
| 1194350066 | Visavis Health Care Medical Group of Ny, Pllc | Family Medicine | 3923 Fort Hamilton Parkway, Brooklyn, NY 11218-1916 | 2020-03-11 |
| 1679106330 | Tanya Sereitha Morant | Family Medicine | 193 17th St, Brooklyn, NY 11215-6977 | 2020-02-20 |
| 1356983167 | Barbara Baptiste | Family Medicine | 4710 Flatlands Ave, Brooklyn, NY 11234 | 2019-10-14 |
| 1043778038 | Carla Ylose Jean-baptiste | Family Medicine | 1000 E 98th St # 2, Brooklyn, NY 11236-2327 | 2019-03-08 |
| 1295201424 | Yente Chesny | Family Medicine | 1122 Chestnut Ave, Brooklyn, NY 11230-5844 | 2018-10-15 |
| Find all providers in BROOKLYN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.