Provider Demographics
NPI:1063408540
Name:DECANCQ, HELAIRE GEORGE JR (MD)
Entity type:Individual
Prefix:DR
First Name:HELAIRE
Middle Name:GEORGE
Last Name:DECANCQ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 HELENDALE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3173
Mailing Address - Country:US
Mailing Address - Phone:585-473-7028
Mailing Address - Fax:585-473-0051
Practice Address - Street 1:500 HELENDALE ROAD
Practice Address - Street 2:STE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:585-473-7028
Practice Address - Fax:585-473-0051
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2009-08-04
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Provider Licenses
StateLicense IDTaxonomies
NY89973208000000X
NY089973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00448779Medicaid