Healthcare Provider Details

I. General information

NPI: 1225976285
Provider Name (Legal Business Name): BRYAN LINARES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SEBER RD BUILDING 5
HACKETTSTOWN NJ
07840
US

IV. Provider business mailing address

38 8TH AVE FL 2
PASSAIC NJ
07055-2121
US

V. Phone/Fax

Practice location:
  • Phone: 908-452-5366
  • Fax:
Mailing address:
  • Phone: 862-334-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01008800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: