Healthcare Provider Details

I. General information

NPI: 1356828628
Provider Name (Legal Business Name): MODERN ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLLARD RD STE C30
LOS GATOS CA
95032-1431
US

IV. Provider business mailing address

PO BOX 321207
LOS GATOS CA
95032-0120
US

V. Phone/Fax

Practice location:
  • Phone: 408-353-0203
  • Fax: 408-353-0204
Mailing address:
  • Phone: 408-356-4959
  • Fax: 408-358-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA147622
License Number StateCA

VIII. Authorized Official

Name: DR. IAN J BARRETT
Title or Position: DOCTOR/ OWNER
Credential: MD
Phone: 201-741-3431