Randolph, Theodore John
Randolph, Theodore John is an sole proprietor health care provider with primary practice located at 3 Medical Dr Suite C, Port Jefferson Station NY 11776-1597. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Randolph, Theodore John can be contacted via phone (631) 928-7785.Contact Information
Primary practice address
3 Medical Dr Suite C
Port Jefferson Station NY 11776-1597
Phone: (631) 928-7785
Fax: (631) 928-0316
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery | 213ES0103X | 003646 | New York |
Profile Details
| NPI number | 1831197318 |
|---|---|
| LBN Legal business name | Randolph, Theodore John |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 8th, 2005 |
| Last updated | Oct 20th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831197318 | NPPES |
| New York | MEDICAID | 791048 |
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