MEDICARE: ENERGY RENEWAL REVOLUTIONIZED UNLTD. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246QL0901X	Diplomate Laboratory Management Specialist/Technologist

General Provider Information

NPI Number	:	1972458909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENERGY RENEWAL REVOLUTIONIZED UNLTD. LLC

Provider Business Mailing Address
First Line	:	1039 WASHINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456
Country	:	US
Telephone Number	:	833-912-3998
Fax Number	:	929-644-6597

Provider Business Practice Location Address
First Line	:	1039 WASHINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456
Country	:	US
Telephone Number	:	833-912-3998
Fax Number	:	929-644-6597

Authorized Official
Title or Position	:	PRINCIPAL INVESTIGATOR
Name	:	MR. DAVID LAMAR HALL
Credential	:
Telephone Number	:	929-909-1468

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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