MR. MICHAEL JOHN FULLAM (NPI# 1255599163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255599163 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL JOHN FULLAM |
| Credential | PA |
| Practice Address |
107 N Ocean Ave Patchogue NY 11772-2012 |
| Mailing Address |
25 Northumberland Dr Shoreham NY 11786-2000 |
| Practice Telephone | 6316545004 |
| Mailing Telephone | 6318466984 |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-05-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 006268 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
107 N OCEAN AVE |
| City | PATCHOGUE |
| State | NY |
| Zip Code | 11772-2012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437206943 | Cherese M Laporta | Family Medicine | 107 N Ocean Ave, Suite G, Patchogue, NY 11772-2012 | 2007-01-05 |
| 1285988642 | Allison P Boyle | Physician Assistant | 107 N Ocean Ave, Patchogue, NY 11772-2012 | 2012-11-06 |
| 1700050051 | Cherese M. Laporta D.o., Pllc | Family Medicine | 107 N Ocean Ave, Suite G, Patchogue, NY 11772-2012 | 2008-04-17 |
| 1861593584 | Shafi Ahmad | Specialist | 107 N Ocean Ave, Suite L, Patchogue, NY 11772-2012 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447224 | Amita Vipul Patel | Nurse Practitioner | Longlsland Community Hospital, 101 Hospital Rd, Patchogue, NY 11772 | 2020-08-13 |
| 1609491968 | Sanjib Dey | Family Medicine | Brookhaven Nephrology Associates, 260 E. Patchogue-yaphank Rd., Patchogue, NY 11772 | 2020-06-12 |
| 1992297204 | Camila Bueno-sanchez | Student in an Organized Health Care Education/Training Program | 676 S Country Rd, East Patchogue, NY 11772 | 2018-06-01 |
| 1184115859 | Premier Endodontics of Patchogue | Dentist | 44 Medford Avenue, Patchogue, NY 11772 | 2018-05-29 |
| 1801386453 | Franklin Ikechukwu Ugbode | Student in an Organized Health Care Education/Training Program | 100 Hospital Road Suite 201, Patchogue, NY 11772 | 2018-05-18 |
| 1508372335 | Stephanie Vanschaick | Counselor | 450 Waverly Ave Ste 11, Patchogue, NY 11772 | 2017-12-15 |
| 1578074498 | Chrystal Lee Curran | Specialist | 1116 Main Road, Aquebogue, NY 11772 | 2017-10-18 |
| 1013457712 | Candyce Fahner | Registered Nurse | 22 Haig Ave, E Patchogue, NY 11772 | 2017-02-28 |
| 1992251631 | Vanessa Lynn Petoello | Nurse Practitioner | 107 N/ Ocean Ave, Suite G, Patchogue, NY 11772 | 2016-09-01 |
| 1811343809 | Andrew Vanderlofske | Nurse Practitioner | 144 North Ocean Avenue, Patchogue, NY 11772 | 2016-05-09 |
| Find all providers in zip 11772 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295385920 | Lorena Mcclure | Physician Assistant | 77 Waverly Ave Apt 413, Patchogue, NY 11772-8301 | 2019-09-15 |
| 1023663184 | Genevieve Wood-minardi | Physician Assistant | 107 N Ocean Ave Ste G, Patchogue, NY 11772-2012 | 2019-08-06 |
| 1225594351 | Steven Bender | Physician Assistant | 30 Avery Ave, Patchogue, NY 11772-2902 | 2019-02-13 |
| 1831600881 | Gulbin Antapli-zeb | Physician Assistant | 440 Waverly Ave Ste 11, Patchogue, NY 11772-7601 | 2017-10-17 |
| 1043660012 | Stephanie Salinas | Physician Assistant | 65 E Woodside Ave, Patchogue, NY 11772-1312 | 2016-06-20 |
| 1548884406 | Samantha Giordano | Physician Assistant | 73 S Ocean Ave, Patchogue, NY 11772-3702 | 2020-06-05 |
| 1679049456 | Shannon Faith Landry | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772 | 2018-10-18 |
| 1306311600 | Adrian S Krueger | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-10-12 |
| 1043791882 | Kathryn Elizabeth Walton | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-28 |
| 1013496579 | Courtney Bofinger | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-07 |
| Find all providers in PATCHOGUE | ||||
Please comment or provide details below to improve the information on MR. MICHAEL JOHN FULLAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.