Healthcare Provider Details

I. General information

NPI: 1538085998
Provider Name (Legal Business Name): PROTERA SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N CENTRE AVE STE 303
ROCKVILLE CENTRE NY
11570-6300
US

IV. Provider business mailing address

100 N CENTRE AVE STE 303
ROCKVILLE CENTRE NY
11570-6300
US

V. Phone/Fax

Practice location:
  • Phone: 347-378-6459
  • Fax: 718-732-2906
Mailing address:
  • Phone: 347-378-6459
  • Fax: 718-732-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TYLER NEUBERG
Title or Position: PRESIDENT
Credential:
Phone: 516-770-6979