Mutyala, Manikyam

Mutyala, Manikyam is an individual health care provider with primary practice located at 276 85Th Ave , Floral Park NY 11001-1205. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Mutyala, Manikyam can be contacted via phone (516) 358-1674.

Contact Information

Primary practice address
276 85Th Ave Floral Park NY 11001-1205
Phone: (516) 358-1674
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 229717-1 New York
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 229717-1 New York

Profile Details

NPI number 1326068198
LBN Legal business name Mutyala, Manikyam
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Oct 17th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326068198 NPPES
New York MEDICAID 02559171

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