Provider Demographics
NPI:1033269378
Name:VALLEY SPINE SPECIALISTS, PC
Entity Type:Organization
Organization Name:VALLEY SPINE SPECIALISTS, PC
Other - Org Name:GERARD J. FOTI, D.O.
Other - Org Type:Other Name
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-802-0360
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-0384
Mailing Address - Country:US
Mailing Address - Phone:570-802-0360
Mailing Address - Fax:570-802-0363
Practice Address - Street 1:695 E 16TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2320
Practice Address - Country:US
Practice Address - Phone:570-802-0360
Practice Address - Fax:570-802-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 009073L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03278001OtherCAPITAL BLUE CROSS
PA794395OtherAETNA
PA815090OtherFIRST PRIORITY HEALTH
PA201048OtherFIRST HEALTH
PA0019018160001Medicaid
PA1392229OtherBLUE SHIELD
PA1392229OtherAMERIHEALTH
PA1394738OtherKEYSTONE HEALTH PLAN
PA72565OtherGEISINGER HEALTH PLAN
PA201048OtherFIRST HEALTH
H67093Medicare UPIN