MICHAEL JOHN FULLAM

PATCHOGUE, NY
NPI1255599163
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NY  006268)
Enumeration Date2008-05-28
Last Update Date2021-02-25
Business Address
MR. MICHAEL JOHN FULLAM PA
107 N OCEAN AVE
PATCHOGUE, NY 11772-2012
Phone number: 631-654-5004
Mailing Address
MR. MICHAEL JOHN FULLAM PA
25 NORTHUMBERLAND DR
SHOREHAM, NY 11786-2000
Phone number: 631-846-6984
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