Provider Demographics
NPI:1356828628
Name:MODERN ORTHOPEDICS PC
Entity Type:Organization
Organization Name:MODERN ORTHOPEDICS PC
Other - Org Name:MODERN ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-741-3431
Mailing Address - Street 1:PO BOX 321207
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0120
Mailing Address - Country:US
Mailing Address - Phone:408-356-4959
Mailing Address - Fax:408-358-8692
Practice Address - Street 1:800 POLLARD RD STE C30
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1431
Practice Address - Country:US
Practice Address - Phone:408-353-0203
Practice Address - Fax:408-353-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147622207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty