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Theodore Randolph, D.P.M
NPI 1831197318 · on the registry since 2005 · sole proprietor
Practice
- Address
- 3 Medical Dr
Suite C
Port Jefferson Station, NY 11776 - Phone
- (631) 928-7785
- Fax
- (631) 928-0316
- Organisation at this address
- Theodore Randolph,Dpm
Victoria E. Shack, Dds, Pc
Leanne M Molia, M.D., P.C.
M. H. Mandelbaum Orthotic & Prosthetic Services, Inc.Inferred from a shared address, not stated in the registry. - Clinicians at this address
- 5
Registry record
- Primary taxonomy
- Foot & Ankle Surgery Podiatrist
213ES0103X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2011-10-20
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York