Healthcare Provider Details

I. General information

NPI: 1063408540
Provider Name (Legal Business Name): HELAIRE GEORGE DECANCQ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HELENDALE ROAD STE 200
ROCHESTER NY
14609-3173
US

IV. Provider business mailing address

500 HELENDALE RD STE 200
ROCHESTER NY
14609-3173
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-7028
  • Fax: 585-473-0051
Mailing address:
  • Phone: 585-473-7028
  • Fax: 585-473-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number89973
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number089973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: