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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | CUSTIS, KEVIN | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1811976970 | [sources] | |||
| Sector | MD | [sources] | |||
| Status | not available | [sources] | |||
| Address | 908 MAIN STREET, ASBURY PARK, NJ 07712 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers disqualified from participating in New Jersey State's Medicaid program.
United States of America · OIFP
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | New Jersey Office of the State Comptroller | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| 908 MAIN STREET, ASBURY PARK, NJ 07712 | United States of America | |