Healthcare Provider Details

I. General information

NPI: 1629915756
Provider Name (Legal Business Name): DARYLE A RUARK MD ORTHOPEDIC SURGEON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 HARTFORD TPKE
VERNON CT
06066-4763
US

IV. Provider business mailing address

224 HARTFORD TPKE
VERNON CT
06066-4763
US

V. Phone/Fax

Practice location:
  • Phone: 860-728-6740
  • Fax: 860-547-1554
Mailing address:
  • Phone: 860-728-6740
  • Fax: 860-547-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J GROSSO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 516-662-8708