Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Beacon Christian Community Health Center, Inc

Organization Family Medicine Physician · NPI 1639246358

Beacon Christian Community Health Center, Inc provides Family Medicine Physician services in Staten Island, New York. Licensed in New York. Registered with an NPI since 2006.

Licensed in
NY
In the registry since
2006
Specialties on file
6
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2079 Forest Ave
Staten Island, NY 10303-1735
Phone: (718) 815-6560
Fax: (718) 815-6576
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Federally Qualified Health Center (FQHC) (primary) Taxonomy 261QF0400X
Family Medicine Physician Taxonomy 207Q00000X · Licence 7004209R (NY)
Internal Medicine Physician Taxonomy 207R00000X · Licence 7004209R (NY)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 7004209R (NY)
Pediatrics Physician Taxonomy 208000000X · Licence 7004209R (NY)
Podiatrist Taxonomy 213E00000X · Licence 7004209R (NY)

Record details

NPI number1639246358
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Kim — Ceo · (718) 815-6560
NPI enumeratedNovember 29, 2006
Last updated in NPPESApril 7, 2023
Certification dateApril 7, 2023
Mailing address2079 Forest Ave, Staten Island, NY 10303-1735

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