Provider Demographics
NPI:1770742827
Name:GUY RODRIGUEZ, EVA PORTER (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:PORTER
Last Name:GUY RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:ATTN; MARIA FIGUEROA, NEWARK BETH ISRAEL MED CTR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112
Mailing Address - Country:US
Mailing Address - Phone:973-926-7466
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA104380002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0643998Medicaid