Healthcare Provider Details

I. General information

NPI: 1154307239
Provider Name (Legal Business Name): THOMAS C. RANDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3410
  • Fax:
Mailing address:
  • Phone: 212-305-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number330537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: