Individual provider · Type 1 NPI
Theodore John Randolph, D.P.M
Foot & Ankle Surgery Podiatrist · Port Jefferson Station, NY
NPI number
1831197318
Active
Practice location
3 Medical Dr, Suite C
Port Jefferson Station, NY 11776-1597
Fax (631) 928-0316
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | 003646 (NY) |
Foot & Ankle Surgery Podiatrist: Definition to come...
2 other providers at this address
Other foot & ankle surgery podiatrist providers in Port Jefferson Station
About NPI 1831197318
Theodore John Randolph, D.P.M's National Provider Identifier is 1831197318, issued on Jul 8, 2005. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Port Jefferson Station, NY. The record was last updated on Oct 20, 2011.