Healthcare Provider Details
I. General information
NPI: 1427033455
Provider Name (Legal Business Name): JEFFREY FRANCIS GRYN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/13/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1100 MEADE ST
DUNMORE PA
18512
US
IV. Provider business mailing address
1100 MEADE ST
DUNMORE PA
18512-3169
US
V. Phone/Fax
- Phone: 570-342-3675
- Fax: 570-342-3316
- Phone: 570-342-3675
- Fax: 570-342-3316
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RH0000X |
| Taxonomy | Hematology (Internal Medicine) Physician |
| License Number | MD029694E |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RX0202X |
| Taxonomy | Medical Oncology Physician |
| License Number | MD029694E |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0003X |
| Taxonomy | Hematology & Oncology Physician |
| License Number | MD029694E |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 84400692 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 2 | |
| Identifier | 1508424 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GATEWAY |
| # 3 | |
| Identifier | 000927308 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | ION HEALTH MEDICAID HMO |
| # 4 | |
| Identifier | 0009273080006 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 5 | |
| Identifier | 3503772 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA PIN FOR HMOS |
| # 6 | |
| Identifier | 000000152639 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNISON MEDPLUS |
| # 7 | |
| Identifier | C34153 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH AMERICA PIN |
| # 8 | |
| Identifier | 000000351803 |
| Identifier Type | OTHER |
| Identifier State | OH |
| Identifier Issuer | ANTHEM BCBS |
| # 9 | |
| Identifier | 0009273080005 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 2455418 |
| Identifier Type | MEDICAID |
| Identifier State | OH |
| Identifier Issuer | |
| # 11 | |
| Identifier | 4356942 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA PIN FOR PPOS |
| # 12 | |
| Identifier | P0096493 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROAD MEDICARE |
| # 13 | |
| Identifier | GR438116 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HIGHMARK BCBS PIN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
