Theodore John Randolph, D.P.M

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

003646 Issued in NY

Practice address

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

Phone

(631) 928-7785

Fax

(631) 928-0316

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1831197318",
    "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": {
        "last_name": "RANDOLPH",
        "first_name": "THEODORE",
        "middle_name": "JOHN",
        "credential": "D.P.M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_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": []
}

• Stephen Rabeno, PHD, LCSW-R
• Radiological Imaging Solutions PLLC
• Rebecca Rainendez, LMHC
• Jacqueline Rambo, M.S.
• Marilyn Savitri Ramdeen, LPN
• Diane Ranieri, PA
• Julia Ranieri
• Paul David Ravener, D.C.
• Gerianne Mary Ray, M.A.
• Satabdi Ray

• 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 Oct 20, 2011; 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.