THEODORE RANDOLPHDPM NPI 1720264252

NPI Information

  • NPI: 1720264252
  • Provider Name: THEODORE RANDOLPH,DPM
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Organization
  • Address: 3 MEDICAL DR
    SUITE C
    PORT JEFFERSON STATION, NY
    ZIP 11776
  • Phone: (631) 928-7785

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NPI Details

THEODORE RANDOLPH,DPM is a foot and ankle surgery podiatrist in Port Jefferson Station, NY. THEODORE RANDOLPH,DPM NPI is 1720264252. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3 MEDICAL DR
SUITE C
PORT JEFFERSON STATION, NY
ZIP 11776-597
Phone: (631) 928-7785
Fax: (631) 928-0316

The provider's authorized official is Theodore John Randolph .
The authorized official title is Owner and has the following contact phone number (631) 928-7785.

The enumeration date for this NPI number is 1/15/2008 and was last updated on 1/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0103XPodiatristFoot & Ankle Surgery003646NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1791048MEDICAIDNEW YORK
2P92181MEDICARE PINNEW YORK
3T45593MEDICARE UPINNEW YORK
41092330001MEDICARE NSCNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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