Organization
MANI VASCULAR SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANIKYAM MUTYALA (M.D.)
(516) 313-5639
Entity
Organization
Contact information
Practice address
6519 BORDEN AVE, MASPETH, NY 11378-1630
(516) 513-5639
Mailing address
340 WILLIS AVE, SYOSSET, NY 11791-3031
(516) 513-5639
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
229717
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
229717
LICENSE
NY
Enumeration date
06/13/2014
Last updated
06/13/2014
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