Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Theodore Randolph, DPM

Organization Foot & Ankle Surgery Podiatrist · NPI 1720264252

Theodore Randolph, DPM is a Foot & Ankle Surgery Podiatrist in Port Jefferson Station, New York. Licensed in New York. Registered with an NPI since 2008.

Licensed in
NY
In the registry since
2008

Practice location Address checks out

3 Medical Dr Ste C
Port Jefferson Station, NY 11776-1597
Phone: (631) 928-7785
Fax: (631) 928-0316
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foot & Ankle Surgery Podiatrist (primary) Taxonomy 213ES0103X · Licence 003646 (NY)

Record details

NPI number1720264252
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Theodore Randolph — Owner · (631) 928-7785
NPI enumeratedJanuary 15, 2008
Last updated in NPPESJanuary 16, 2008
Mailing address3 Medical Dr, Suite C, Port Jefferson Station, NY 11776-1597

Other providers in Port Jefferson Station