Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Beacon Christian Community Health Center, Inc

Organization Family Medicine Physician · NPI 1639246358

Beacon Christian Community Health Center, Inc is a Family Medicine Physician 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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