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NPI Code Detail

MEDICARE: MR. JOHN M. RANDALL

MEDICARE: MR. JOHN M. RANDALL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor007553NY

General Provider Information

NPI Number : 1386076297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN M. RANDALL
Provider Business Mailing Address
First Line : 335 W 1ST ST
Second Line :
City : OSWEGO
State : NY
Zip : 13126-3655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2013
Last Update Date : 07/01/2025

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