Theodore Randolph,DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

003646 Issued in NY

Legal business name

THEODORE RANDOLPH,DPM

Practice address

3 Medical Dr
Suite C
Port Jefferson Station, NY 11776-1597

Phone

(631) 928-7785

Fax

(631) 928-0316

NPI assigned

Jan 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theodore John Randolph, DPM

Title

Owner

Phone

(631) 928-7785

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1720264252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR",
            "address_2": "SUITE C",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-928-7785",
            "fax_number": "631-928-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR",
            "address_2": "SUITE C",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-928-7785",
            "fax_number": "631-928-0316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE RANDOLPH,DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-928-7785",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "003646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "791048",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terryville Fire District
• Terryville Medical Associates
• Terryville Medical Associates
• The Family Tree Psychiatric & Medical Services
• The Way of Acupuncture P.C.
• Anthony C Theodoris, M.D.
• Thomas P. Erhart DO PC
• Shani Thomas
• Lori Thompson, LMHC; NCC
• Lynnette Thompson, LPN

• Foot & Ankle Surgery Podiatrist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Foot & Ankle Surgery Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.