Healthcare Provider Details

I. General information

NPI: 1932138096
Provider Name (Legal Business Name): JOEL PECK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-115 AIEA HEIGHTS DR SUITE 219A
AIEA HI
96701-3924
US

IV. Provider business mailing address

590 FARRINGTON HWY SUITE 210-307
KAPOLEI HI
96707-2009
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-5855
  • Fax:
Mailing address:
  • Phone: 808-256-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL S. PECK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-256-8800