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THEODORE JOHN RANDOLPH D.P.M
NPI 1831197318
Podiatrist - Foot & Ankle Surgery in Port Jefferson Station, NY

Active since July 08, 2005
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: October 20, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Theodore John Randolph D.p.m NPPES

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

THEODORE JOHN RANDOLPH D.P.M (NPI 1831197318) is an individual foot & ankle surgery provider in Port Jefferson Station, New York, licensed in New York (003646) and active in the NPI registry since July 2005.

NPPES Registry Identity

NPI1831197318
Entity TypeIndividualMale
Primary Taxonomy213ES0103X
Provider Legal NameTHEODORE JOHN RANDOLPHCredential: D.P.M
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
Sole ProprietorYes
Enumeration DateJuly 8, 2005
Last NPPES UpdateOctober 20, 2011
✔ NPI 1831197318 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
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Other Identifiers 3

Medicare UPINT45593
Medicare ID-Type UnspecifiedP92181NY
Medicaid791048NY

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 RANDOLPH,DPM
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's NPI number?

The NPI number for Theodore Randolph is 1831197318. It was assigned to this individual provider in the NPPES registry on July 8, 2005.

Where is Theodore Randolph located?

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

What is Theodore Randolph'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 was last updated on October 20, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.