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THEODORE RANDOLPH,DPM
NPI 1720264252
Podiatrist - Foot & Ankle Surgery in Port Jefferson Station, NY

Active since January 15, 2008
3 MEDICAL DR, SUITE C, PORT JEFFERSON STATION, NY 11776(631) 928-7785(631) 928-0316 Get Directions Write a Review

NPPES record last updated: January 16, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Theodore Randolph,dpm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THEODORE RANDOLPH,DPM (NPI 1720264252) is a healthcare organization registered as a foot & ankle surgery in Port Jefferson Station, New York and active in the NPI registry since January 2008. The organization lists Theodore John Randolph, Owner, as its authorized official.

NPPES Registry Identity

NPI1720264252
Entity TypeOrganization
Primary Taxonomy213ES0103X
Legal Business NameTHEODORE RANDOLPH,DPM
Location Address3 MEDICAL DR, SUITE CPort Jefferson Station, NY 11776-1597
Mailing Address3 Medical Dr, Suite CPort Jefferson Station, NY 11776-1597 · (631) 928-7785 · Fax (631) 928-0316
Phone(631) 928-7785
Fax(631) 928-0316
Organization SubpartNo
Authorized OfficialTheodore John RandolphOwner · (631) 928-7785
Enumeration DateJanuary 15, 2008
Last NPPES UpdateJanuary 16, 2008
✔ NPI 1720264252 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in NY · 003646
3 MEDICAL DR, Port Jefferson Station, NY 11776
Open in Google Maps ↗

Other Identifiers 4

Medicaid791048NY
Medicare PINP92181NY
Medicare UPINT45593NY
Medicare NSC1092330001NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORIA E. SHACK, DDS, PC
Dentist
3 MEDICAL DR, SUITE D
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 928-7500
DR. DAVID NATHAN D.D.S.
Dentist (General Practice)
3 MEDICAL DR, SUITE D
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 928-7500
THEODORE JOHN RANDOLPH D.P.M
Podiatrist (Foot & Ankle Surgery)
3 MEDICAL DR, SUITE C
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 928-7785

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Randolph,dpm's NPI number?

The NPI number for Theodore Randolph,dpm is 1720264252. It was assigned to this organization in the NPPES registry on January 15, 2008.

Where is Theodore Randolph,dpm located?

Theodore Randolph,dpm is located at 3 Medical Dr Suite C, Port Jefferson Station, NY 11776. The listed phone number is (631) 928-7785.

What is Theodore Randolph,dpm's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

When was this NPI record last updated?

The NPPES record for Theodore Randolph,dpm was last updated on January 16, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.