THEODORE JOHN RANDOLPH D.P.M NPI 1831197318

NPI Information

  • NPI: 1831197318
  • Provider Name: THEODORE JOHN RANDOLPH, D.P.M
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3 MEDICAL DR
    SUITE C
    PORT JEFFERSON STATION, NY
    ZIP 11776
  • Phone: (631) 928-7785

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NPI Details

Theodore John Randolph, D.P.M is a foot and ankle surgery podiatrist in Port Jefferson Station, NY. Theodore John Randolph, D.P.M NPI is 1831197318. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

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 NPI 1831197318 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 7/8/2005 and was last updated on 10/20/2011.

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
1T45593MEDICARE UPIN
2P92181MEDICARE ID-TYPE UNSPECIFIEDNEW YORK
3791048MEDICAIDNEW 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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