Kevin Tyrone Custis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

211807 Issued in NY

Practice address

86 E 49TH St
Suite a
Brooklyn, NY 11203-1901

Phone

(718) 363-6675

NPI assigned

Jan 16, 2006

Last updated

Sep 26, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kevin T Custis M D P C

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1376511881
  Authorized official Same address or phone
• Lifeline Psychological, P.C.

  • Clinical Psychologist
  • Brooklyn, NY
  • NPI 1154590990
  NPD (past)
• Suny Downstate Medical Center

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1699704155
  NPD (past)

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348617600000",
    "number": "1811976970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 MEADOW LARK LN",
            "city": "BELLE MEAD",
            "state": "NJ",
            "postal_code": "085024929",
            "telephone_number": "908-281-7591",
            "fax_number": "908-431-9329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 E 49TH ST",
            "address_2": "SUITE A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031901",
            "telephone_number": "718-363-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTIS",
        "first_name": "KEVIN",
        "middle_name": "TYRONE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2012-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "211807",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA08719200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01976654",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• India M Cusack
• Dana D Cusato
• Riley Cushing, FNP-C
• Carla Cusimano, M.A.
• Brailee Custer
• Mary Rose L Custodio
• Custom Chemists Inc. (Davids Pharmacy LTC)
• Custom Chemists Inc. (David's Pharmacy)
• Custom Equipment Ny Inc
• Barbara Ann Cusumano

• Family Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.