NJ-Brooklyn Medical Associates, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA08719200 Issued in NJ

Legal business name

NJ-BROOKLYN MEDICAL ASSOCIATES, LLC

Practice address

39 W Front St
Keyport, NJ 07735-1209

Phone

(732) 264-2224

Fax

(732) 264-4291

NPI assigned

Aug 7, 2012

Last updated

Aug 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Custis, M.D.

Title

Sole Proprietor

Phone

(732) 264-2224

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1316294572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 WEST FRONT ST.",
            "city": "KEYPORT",
            "state": "NJ",
            "postal_code": "077351209",
            "telephone_number": "732-264-2224",
            "fax_number": "732-264-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 W FRONT ST",
            "city": "KEYPORT",
            "state": "NJ",
            "postal_code": "077351209",
            "telephone_number": "732-264-2224",
            "fax_number": "732-264-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NJ-BROOKLYN MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "CUSTIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "732-264-2224",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08719200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Keyport, NJ
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.