Organization
TACONIC INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATHIAS O ONI-ESELEH SR. (EXECUTIVE DIRECTOR)
(845) 296-1042
Entity
Organization
Contact information
Practice address
872 ROUTE 376, WAPPINGERS FALLS, NY 12590-6464
(845) 296-1042
(845) 296-0801
Mailing address
872 ROUTE 376, WAPPINGERS FALLS, NY 12590-6464
(845) 296-1042
(845) 296-0801
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
—
NY
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NY
Other
Enumeration date
03/23/2017
Last updated
03/23/2017
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