{
"Npi": {
"NPI": "1205537370",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TACONIC INNOVATIONS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "25-35 BEECHWOOD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT VERNON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10553",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-668-9041",
"MailingAddressFaxNumber": "914-668-9044",
"FirstLinePracticeLocationAddress": "25-35 BEECHWOOD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOUNT VERNON",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10553-1055",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-668-9041",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/15/2023",
"LastUpdateDate": "11/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ONI-ESELEH",
"AuthorizedOfficialFirstName": "MATHIAS",
"AuthorizedOfficialMiddleName": "O",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "845-840-9179",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}