Organization
PEDIATRIC NEURODEVELOPMENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AVI E. DOMNITZ-GEBET D.O. (AUTHORIZED REP/ OWNER/ MD)
(636) 778-9212
Entity
Organization
Contact information
Practice address
17300 N OUTER 40 RD, SUITE 205, CHESTERFIELD, MO 63005-1364
(636) 778-9212
Mailing address
17300 N OUTER 40 RD, SUITE 205, CHESTERFIELD, MO 63005-1364
(636) 778-9212
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
12/10/2013
Last updated
12/10/2013
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