Healthcare Provider Details

I. General information

NPI: 1619554292
Provider Name (Legal Business Name): OSCAR JEFFERSON GRYN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 N LEWIS RD STE 101
LIMERICK PA
19468-3521
US

IV. Provider business mailing address

PO BOX 822336
PHILADELPHIA PA
19182-2336
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-1550
  • Fax:
Mailing address:
  • Phone: 610-323-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS023651
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: