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General NPI Number Information
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NPI Number | 1205537370
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Entity Type | Organization
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Legal Business Name | TACONIC INNOVATIONS INC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 25-35 BEECHWOOD AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553-1055
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Country | US
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Telephone | 914-668-9041
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Fax |
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Provider Business Mailing Address
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Address Line | 25-35 BEECHWOOD AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553
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Country | US
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Telephone | 914-668-9041
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Fax | 914-668-9044
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Authorized Official
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Title or Position | CEO
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Name | DR. MATHIAS O ONI-ESELEH SR.
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Credential |
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Telephone | 845-840-9179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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