MEDICARE: ROSEMARIE NIZNIK

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		PA
2	103K00000X	Behavior Analyst	0133002877	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1639532427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE NIZNIK

Provider Business Mailing Address
First Line	:	5708 GLEN HILL DR
Second Line	:
City	:	BETHEL PARK
State	:	PA
Zip	:	15102-2430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARAGON PL STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-1652
Country	:	US
Telephone Number	:	804-562-9997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/31/2025

6800 PARAGON PL STE 420
RICHMOND, VA
23230-1652

Practice Phone: 804-239-7688
Practice Fax:

6800 PARAGON PL STE 200
RICHMOND, VA
23230-1652