The Physical Medicine Clinic LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

THE PHYSICAL MEDICINE CLINIC LLC

Practice address

453 Amboy Ave
Woodbridge, NJ 07095-2960

Phone

(732) 324-4300

Fax

(732) 324-8211

NPI assigned

Jul 11, 2011

Last updated

Feb 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daryl S Mitruska, DCNPI 1104870310

Title

President

Phone

(732) 324-4300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daryl Susan Mitruska, D.C.

  • Chiropractor
  • Woodbridge, NJ
  • NPI 1104870310
  Medicare reassignment Care Compare group NPD Authorized official
• Anjali Sinha, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Teaneck, NJ
  • NPI 1447435334
  Medicare reassignment Care Compare group NPD
• William Ippolito, PA-C

  • Medical Physician Assistant
  • Wall Township, NJ
  • NPI 1396723011
  Medicare reassignment
• Diane Devito, DC

  • Chiropractor
  • Perth Amboy, NJ
  • NPI 1982892923
  NPD
• Ogechi Ukaegbu, DC

  • Chiropractor
  • Perth Amboy, NJ
  • NPI 1730617226
  NPD (past)

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1285922377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 CONVERY BLVD",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088612584"
        },
        {
            "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": {
        "organization_name": "THE PHYSICAL MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "MITRUSKA",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-324-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Cataract Vision Institute LLC
• The Core and More Rehabilitation LLC
• The Dentists of Woodbridge
• The Doctor's Office of Middlesex, P.C. (Middlesex Doctor's Office)
• The Great Atlantic and Pacific Tea Company Inc (A and P Pharmacy)
• Their Place Children's Services LLC
• Their Place Inc.
• Their Place Inc.
• Their Place Inc.
• Their Place Inc.

• Physical Medicine & Rehabilitation Physician in Woodbridge, NJ
• Providers in Woodbridge, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.