Healthcare Provider Details

I. General information

NPI: 1215393699
Provider Name (Legal Business Name): EUGENE SIMON KOFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 05/07/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOUCHER ST
NEW ORLEANS LA
70115-3515
US

IV. Provider business mailing address

1401 FOUCHER ST
NEW ORLEANS LA
70115-3515
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-7001
  • Fax:
Mailing address:
  • Phone: 504-897-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number302651
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number302651
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA11033200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number302651
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: