Active NPI
Kristina Mackenzie Ceravolo
- Dentist
- Irvington, NJ
National Provider Identifier
1154062883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02954300
- Practice address
- 2 Washington Ave
Irvington, NJ 07111-3550 - Phone
- (973) 926-5306
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 063885 | NY | |
| Dentist | 122300000X | 22DI02954300 | NJ | Primary |
Addresses
Primary practice location
2 Washington Ave
Irvington, NJ 07111-3550
Mailing address
722-724 Adams St Apt 9
Hoboken, NJ 07030-2878
Phone (315) 256-8181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02954300 | NJ | MD | Dentist |
| 063885 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778457600000",
"number": "1154062883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "722-724 ADAMS ST APT 9",
"city": "HOBOKEN",
"state": "NJ",
"postal_code": "070302878",
"telephone_number": "315-256-8181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 WASHINGTON AVE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "071113550",
"telephone_number": "973-926-5306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERAVOLO",
"first_name": "KRISTINA",
"middle_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "063885",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02954300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvington, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.