# MANI VASCULAR SURGERY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558775973
- **Authorized official:** DR. MANIKYAM MUTYALA (M.D.)
- **Authorized official phone:** (516) 313-5639

## Contact information

- **Practice address:** 6519 BORDEN AVE, MASPETH, NY 11378-1630
- **Practice address phone:** (516) 513-5639
- **Mailing address:** 340 WILLIS AVE, SYOSSET, NY 11791-3031
- **Mailing address phone:** (516) 513-5639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 229717 | NY | Yes |

## Other

- **Enumeration date:** 06/13/2014
- **Last updated:** 06/13/2014