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Theodore Randolph,Dpm

Foot & Ankle Surgery Podiatrist in Port Jefferson Station, NY · enumerated 2008 · authorized official Theodore Randolph, Owner.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1720264252

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Registry record

Entity type Organization (Type 2)
Legal business name Theodore Randolph,Dpm
Practice address 3 Medical Dr, Suite C, Port Jefferson Station, NY, 11776
Phone (631) 928-7785
Fax (631) 928-0316
Enumeration date Jan 15, 2008
Last updated in NPPES Jan 16, 2008

Taxonomy & classification

213ES0103X Foot & Ankle Surgery Podiatrist Podiatric Medicine & Surgery Service Providers · License 003646 (NY) Primary

Authorized official

Name Theodore Randolph
Title Owner
Phone (631) 928-7785

Other identifiers

Identifier Type State Issuer
791048 Medicaid NY -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Theodore Randolph,Dpm?
The NPI for Theodore Randolph,Dpm is 1720264252, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Theodore Randolph,Dpm?
NPPES lists Theodore Randolph (Owner) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2008-01-16.