MR. Michael John Fullam, PA

NPI #1255599163 in Patchogue, New York

Provider Information

NPI Number: 1255599163
Entity Type: Individual
Name: MR. Michael John Fullam, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: May 28, 2008
Last Updated: Feb 25, 2021

Practice Location

Address: 107 N OCEAN AVE
City: Patchogue
State: New York
ZIP Code: 11772-2012
Phone: (631) 654-5004

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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