Individual provider Active NPI

Daryl Susan Mitruska, D.C.

  • Chiropractor
  • Woodbridge, NJ
National Provider Identifier
1104870310
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
MC04382 Issued in NJ
Practice address
453 Amboy Ave
Woodbridge, NJ 07095-2960
Phone
(732) 324-4300
Fax
(732) 324-8211
NPI assigned
May 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X MC04382 NJ Primary

Addresses

Primary practice location

453 Amboy Ave
Woodbridge, NJ 07095-2960

Mailing address

453 Amboy Ave Ste 1
Woodbridge, NJ 07095-2949
Phone (732) 324-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061213000493 NJ Practitioner - Chiropractic 8729087069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Physical Medicine Clinic LLCGroup PAC ID 0143496885, 2 clinicians

Practice addresses (Care Compare)

453 Amboy Ave
Suite 1
Woodbridge, NJ 07095-2949
Phone (732) 324-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MC04382NJMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
The Physical Medicine Clinic LLC CurrentSince Dec 4, 2011 Accepting new patients

Locations

788 Convery Blvd
Perth Amboy, NJ 08861
Phone (732) 324-4300

453 Amboy Ave
Ste 1
Woodbridge, NJ 07095
Phone (732) 324-4300

453 Amboy Ave
Woodbridge, NJ 07095
Phone (732) 388-4184

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1104870310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 AMBOY AVE STE 1",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070952949",
            "telephone_number": "732-324-4300",
            "fax_number": "732-324-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 AMBOY AVE",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070952960",
            "telephone_number": "732-324-4300",
            "fax_number": "732-324-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRUSKA",
        "first_name": "DARYL",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "MC04382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.