Pediatric Neurodevelopmental Center LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRIC NEURODEVELOPMENTAL CENTER LLC

Practice address

17300 N Outer 40 Rd
Suite 205
Chesterfield, MO 63005-1364

Phone

(636) 778-9212

NPI assigned

Dec 10, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Avi E. Domnitz-Gebet, D.O.

Title

Authorized Rep/ Owner/ MD

Phone

(636) 778-9212

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386633600000",
    "number": "1639500192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD",
            "address_2": "SUITE 205",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-778-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD",
            "address_2": "SUITE 205",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-778-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NEURODEVELOPMENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2013-12-10",
        "status": "A",
        "authorized_official_last_name": "DOMNITZ-GEBET",
        "authorized_official_first_name": "AVI",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "AUTHORIZED REP/ OWNER/ MD",
        "authorized_official_telephone_number": "636-778-9212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.