Theodore John Randolph, D.P.M Valid NPI
Individual provider · Foot & Ankle Surgery Podiatrist · Port Jefferson Station, NY
- NPI
- 1831197318
- Type
- Individual (Type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist (Podiatrist)
- Specialty group
- Podiatric Medicine & Surgery Service Providers
- Taxonomy code
- 213ES0103X
- License number
- 003646 (NY)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2005-07-08
- Last updated
- 2011-10-20
Practice location
3 Medical Dr, Suite C
Port Jefferson Station, NY 11776-1597
(631) 928-7785