Provider Demographics
NPI:1225061849
Name:GABORIAU, HENRI P (MD)
Entity type:Individual
Prefix:
First Name:HENRI
Middle Name:P
Last Name:GABORIAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-713-5300
Mailing Address - Fax:866-506-5573
Practice Address - Street 1:39 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-713-5300
Practice Address - Fax:866-506-5573
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289125207N00000X, 207Y00000X, 207YS0123X
WAMD00037350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04861712Medicaid
WAGAB25913Medicare PIN