Provider Demographics
NPI:1205537370
Name:TACONIC INNOVATIONS INC
Entity type:Organization
Organization Name:TACONIC INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ONI-ESELEH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:845-840-9179
Mailing Address - Street 1:25-35 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:914-668-9041
Mailing Address - Fax:914-668-9044
Practice Address - Street 1:25-35 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1055
Practice Address - Country:US
Practice Address - Phone:914-668-9041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care