Provider Demographics
NPI:1982998258
Name:ENERG LLC
Entity Type:Organization
Organization Name:ENERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GERZENSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-515-8880
Mailing Address - Street 1:4230 E TOWNE BLVD
Mailing Address - Street 2:#288
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3704
Mailing Address - Country:US
Mailing Address - Phone:608-515-8880
Mailing Address - Fax:888-854-1888
Practice Address - Street 1:4230 E TOWNE BLVD
Practice Address - Street 2:#288
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3704
Practice Address - Country:US
Practice Address - Phone:608-515-8880
Practice Address - Fax:888-854-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty