Mr. Michael John Fullam, PA
Mr. Michael John Fullam is a Physician Assistant provider (Physician Assistant) practicing in Patchogue, NY, registered in the NPPES registry with NPI 1255599163 since 2008. The credential PA stands for Physician Assistant. Practices at Cherese M. Laporta D.O., Pllc (listed at the same practice address in NPPES).
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1255599163 |
|---|---|
| Entity type | Individual (Type 1) |
| Name | Mr. Michael John Fullam |
| Credential | PA |
| Sex | Male |
| Practice address | 107 N OCEAN AVE, Patchogue, NY, 11772 |
| Phone | 6316545004 |
| Enumeration date | 2008-05-28 |
| Last updated in NPPES | 2021-02-25 |
Taxonomy & licenses
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | Primary | 006268 | NY |
PA — Physician Assistant: A licensed clinician who practices medicine in collaboration with physicians, trained in a graduate PA program. About the PA credential
Copy-ready billing details
Provider: Michael Fullam, PA NPI: 1255599163 Taxonomy: 363A00000X (Physician Assistant) Address: 107 N OCEAN AVE, Patchogue, NY, 11772
Other providers at this practice address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1437206943 | Cherese Laporta | Individual | Family Medicine Physician | Patchogue, NY |
| 1700050051 | Cherese M. Laporta D.O., Pllc | Organization | Family Medicine Physician | Patchogue, NY |
| 1285988642 | Allison Boyle | Individual | Medical Physician Assistant | Patchogue, NY |
| 1992251631 | Vanessa Petoello | Individual | Adult Health Nurse Practitioner | Patchogue, NY |
Verify this record
Cross-check NPI 1255599163 against the authoritative CMS record: view Mr. Michael John Fullam on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2021-02-25.