Healthcare Provider Details

I. General information

NPI: 1629996509
Provider Name (Legal Business Name): ANTONIA POLYVIOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 BROAD ST
BLOOMFIELD NJ
07003-3045
US

IV. Provider business mailing address

1067 POMPTON AVE APT 1B
CEDAR GROVE NJ
07009-1157
US

V. Phone/Fax

Practice location:
  • Phone: 862-261-2184
  • Fax:
Mailing address:
  • Phone: 201-983-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: