Pediatric Neurodevelopmental Center LLC
NPI #1639500192 in Chesterfield, Missouri
Provider Information
- NPI Number
- 1639500192
- Entity Type
- Organization
- Organization Name
- Pediatric Neurodevelopmental Center LLC
- Primary Specialty
- Pediatrics
- Enumeration Date
- Dec 10, 2013
- Last Updated
- Dec 10, 2013
Practice Location
- Address
- 17300 N OUTER 40 RD
- Address 2
- SUITE 205
- City
- Chesterfield
- State
- Missouri
- ZIP Code
- 63005-1364
- Phone
- (636) 778-9212
Authorized Official
- Name
- DR. AVI E. DOMNITZ-GEBET, D.O.
- Title
- AUTHORIZED REP/ OWNER/ MD
- Phone
- (636) 778-9212
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pediatrics |
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