Provider Demographics
NPI:1932138096
Name:JOEL PECK MD INC
Entity Type:Organization
Organization Name:JOEL PECK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-256-8800
Mailing Address - Street 1:590 FARRINGTON HWY
Mailing Address - Street 2:SUITE 210-307
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:808-256-8800
Mailing Address - Fax:
Practice Address - Street 1:99-115 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 219A
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-485-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH54668Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER