Individual
MANIKYAM MUTYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
276 85TH AVE, FLORAL PARK, NY 11001-1205
(516) 358-1674
Mailing address
14601 45TH AVE STE 315, FLUSHING, NY 11355-2280
(718) 670-5473
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
229717-1
NY
208600000X
Surgery Physician
229717-1
NY
2086S0129X
Vascular Surgery Physician
Primary
229717-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02559171
—
NY
Enumeration date
07/21/2006
Last updated
04/29/2026
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