# TACONIC INNOVATIONS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841721644
- **Authorized official:** MR. MATHIAS O ONI-ESELEH SR. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (845) 296-1042

## Contact information

- **Practice address:** 872 ROUTE 376, WAPPINGERS FALLS, NY 12590-6464
- **Practice address phone:** (845) 296-1042
- **Practice address fax:** (845) 296-0801
- **Mailing address:** 872 ROUTE 376, WAPPINGERS FALLS, NY 12590-6464
- **Mailing address phone:** (845) 296-1042
- **Mailing address fax:** (845) 296-0801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NY | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NY | Yes |

## Other

- **Enumeration date:** 03/23/2017
- **Last updated:** 03/23/2017