person
Theodore John Randolph, DPM
Foot & Ankle Surgery Podiatrist in Port Jefferson Station, New York
NPI 1831197318

Theodore John Randolph is a Foot & Ankle Surgery Podiatrist based in Port Jefferson Station, NY and is specialized in Foot & Ankle Surgery. Theodore John Randolph practices in Port Jefferson Station, NY and has the professional credentials of DPM. The NPI Number for Theodore John Randolph is 1831197318 and holds a License No. 003646 (New York).

The current practice location address for Theodore John Randolph is 3 Medical Dr, Port Jefferson Station, NY and can be reached out via phone at 631-928-7785 and via fax at 631-928-0316.

Location: 3 Medical Dr, Port Jefferson Station, NY, 11776-1597
person
Provider Profile Details
NPI Number
1831197318
Provider Name
Theodore John Randolph
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
3 Medical Dr, Port Jefferson Station, NY, 11776-1597
Phone Number
631-928-7785
Fax Number
631-928-0316
Provider Enumeration Date
07/08/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
791048 05 NY
institution
Provider Business Practice Location Address Details
Address
3 Medical Dr
City
State
Zip
11776-1597
Phone Number
631-928-7785
Fax Number
631-928-0316
person
Provider Business Mailing Address Details
Address
3 Medical Dr
City
State
Zip
11776-1597
Phone Number
631-928-7785
Fax Number
631-928-0316
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
License No.
003646 (New York)
Definition
Definition to come...
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