Dr. Christian N Ezidiegwu specialises in Blood Banking & Transfusion Medicine. He currently works at Faxton-St Luke's Healthcare in New York and has affiliate with 1 other institution.
| NPI Number | 1053364802 |
| Provider Name | Christian N Ezidiegwu |
| Credential | MD |
| Specialization | Blood Banking & Transfusion Medicine |
| Medical School Name | Other |
| Graduation Year | 1986 |
| Gender | M |
| Entity Type | Individual |
| PAC ID by PECOS | 5496746463 |
| Professional Enrollment ID | I20040519000662 |
| Enumeration Date | 05/19/2006 |
| Last Update Date | 07/08/2007 |
| Business Practice address |
100 OSTROM AVE, Syracuse, 13210-2029 New York View on Google Map |
| Business Practice phone | 315-447-7041 |
| Business Practice fax | |
| Mailing address |
100 OSTROM AVE, Syracuse, 13210-2029 New York View on Google Map |
| Other phone | 315-447-7041 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Syracuse, New York
St Elizabeth Medical Center
Other
Blood Banking & Transfusion Medicine, 1986
| Field Name | Field Value |
|---|---|
| NPI | 1053364802 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
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| Is Sole Proprietor | X |
Indicate whether provider is a sole proprietor.
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| Provider Last Name (Legal Name) | Ezidiegwu |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Christian |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | MD |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 100 OSTROM AVE |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Syracuse |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | New York |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 13210-2029 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 315-447-7041 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 100 OSTROM AVE |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | Syracuse |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | New York |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 13210-2029 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 315-447-7041 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 05/19/2006 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 07/08/2007 |
| The date that a record was last updated or changed. | |
| Provider Gender Code | M |
| The code designating the provider's gender if the provider is a person. | |
| Provider Gender | Male |
| The provider's gender if the provider is a person. | |
| Healthcare Provider Taxonomy Code #1 | 207ZB0001X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | A physician who specializes in blood banking/transfusion medicine is responsible for the maintenance of an adequate blood supply, blood donor and patient-recipient safety and appropriate blood utilization. Pre-transfusion compatibility testing and antibody testing assure that blood transfusions, when indicated, are as safe as possible. This physician directs the preparation and safe use of specially prepared blood components, including red blood cells, white blood cells, platelets and plasma constituents, and marrow or stem cells for transplantation. |
| Healthcare Provider Taxonomy #1 | |
| Provider License Number 1 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 1 | NY |
| Provider License Number State Code #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 207ZC0500X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | A cytopathologist is an anatomic pathologist trained in the diagnosis of human disease by means of the study of cells obtained from body secretions and fluids, by scraping, washing, or sponging the surface of a lesion, or by the aspiration of a tumor mass or body organ with a fine needle. A major aspect of a cytopathologist's practice is the interpretation of Papanicolaou-stained smears of cells from the female reproductive systems, the "Pap" test. However, the cytopathologist's expertise is applied to the diagnosis of cells from all systems and areas of the body. He/she is a consultant to all medical specialists. |
| Healthcare Provider Taxonomy #2 | |
| Provider License Number 2 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 2 | NY |
| Provider License Number State Code #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 207ZD0900X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. |
| Healthcare Provider Taxonomy #3 | |
| Provider License Number 3 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 3 | NY |
| Provider License Number State Code #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 207ZF0201X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | A forensic pathologist is expert in investigating and evaluating cases of sudden, unexpected, suspicious and violent death as well as other specific classes of death defined by law. The forensic pathologist serves the public as coroner or medical examiner, or by performing medicolegal autopsies for such officials. |
| Healthcare Provider Taxonomy #4 | |
| Provider License Number 4 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 4 | NY |
| Provider License Number State Code #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #5 | 207ZI0100X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | A pathologist who specializes in the diagnosis of immunologic diseases. |
| Healthcare Provider Taxonomy #5 | |
| Provider License Number 5 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 5 | NY |
| Provider License Number State Code #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #6 | 207ZM0300X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 6 | A medical microbiologist is expert in the isolation and identification of microbial agents that cause infectious disease. Viruses, bacteria and fungi, as well as parasites, are identified and, where possible, tested for susceptibility to appropriate antimicrobial agents. |
| Healthcare Provider Taxonomy #6 | |
| Provider License Number 6 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 6 | NY |
| Provider License Number State Code #6 | |
| Healthcare Provider Primary Taxonomy Switch 6 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #7 | 207ZP0007X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 7 | A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, disorders of human development, infectious diseases and malignancies, and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function and alteration and applies laboratory techniques for diagnosis, treatment and prognosis for individuals with related disorders. |
| Healthcare Provider Taxonomy #7 | |
| Provider License Number 7 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 7 | NY |
| Provider License Number State Code #7 | |
| Healthcare Provider Primary Taxonomy Switch 7 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #8 | 207ZP0007X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 8 | A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, disorders of human development, infectious diseases and malignancies, and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function and alteration and applies laboratory techniques for diagnosis, treatment and prognosis for individuals with related disorders. |
| Healthcare Provider Taxonomy #8 | |
| Provider License Number 8 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 8 | NY |
| Provider License Number State Code #8 | |
| Healthcare Provider Primary Taxonomy Switch 8 | X |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #9 | 207ZP0213X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 9 | A pediatric pathologist is expert in the laboratory diagnosis of diseases that occur during fetal growth, infancy and child development. The practice requires a strong foundation in general pathology and substantial understanding of normal growth and development, along with extensive knowledge of pediatric medicine. |
| Healthcare Provider Taxonomy #9 | |
| Provider License Number 9 | 230913 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 9 | NY |
| Provider License Number State Code #9 | |
| Healthcare Provider Primary Taxonomy Switch 9 | X |
Primary Taxonomy:
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