Healthcare Provider Details

I. General information

NPI: 1225061849
Provider Name (Legal Business Name): HENRI P GABORIAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WEST MAIN STREET
CANTON NY
13617
US

IV. Provider business mailing address

39 WEST MAIN STREET
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 315-713-5300
  • Fax: 866-506-5573
Mailing address:
  • Phone: 315-713-5300
  • Fax: 866-506-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number289125
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00037350
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number289125
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number289125
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: