=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225061849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HENRI P GABORIAU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 WEST MAIN STREET
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-713-5300
-----------------------------------------------------
Fax | 866-506-5573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 WEST MAIN STREET
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-713-5300
-----------------------------------------------------
Fax | 866-506-5573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 289125
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD00037350
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 289125
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207YS0123X
-----------------------------------------------------
Taxonomy Name | Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 289125
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------