Organization
BEACON CHRISTIAN COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET KIM M.D., MPH, MA (CHIEF MEDICAL OFFICER)
(718) 815-6560
Entity
Organization
Contact information
Practice address
2079 FOREST AVE, STATEN ISLAND, NY 10303-1865
(718) 815-6560
(718) 815-6576
Mailing address
2079 FOREST AVE, STATEN ISLAND, NY 10303-1865
(718) 815-6560
(718) 815-6576
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133V00000X
—
NJ
05
—
133V00000X
—
NY
Enumeration date
07/30/2015
Last updated
07/30/2015
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