Organization
NORTHEAST NEUROSCIENCE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR G. SONNINO M.D. (PHYSICIAN OWNER)
(252) 335-9900
Entity
Organization
Contact information
Practice address
100 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 335-9900
(252) 335-9920
Mailing address
100 MEDICAL DR, ELIZABETH CITY, NC 27909-3361
(252) 335-9900
(252) 335-9920
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1273X
BCBS
NC
05
—
891273X
—
NC
01
—
DC7828
RR MCARE / PALMETTO GBA
—
Enumeration date
10/18/2005
Last updated
08/22/2020
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