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 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4317
Mailing Address - Fax:315-769-4353
Practice Address - Street 1:181 MAPLE ST STE A
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1052
Practice Address - Country:US
Practice Address - Phone:315-842-3024
Practice Address - Fax:315-842-3035
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037350174400000X
NY289125207N00000X, 207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04861712Medicaid
WAGAB25913Medicare PIN