Healthcare Provider Details

I. General information

NPI: 1043012370
Provider Name (Legal Business Name): SLEC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1012
US

IV. Provider business mailing address

625 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1012
US

V. Phone/Fax

Practice location:
  • Phone: 646-489-0738
  • Fax:
Mailing address:
  • Phone: 646-489-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HEATHER LOTTNER
Title or Position: OWNER
Credential:
Phone: 646-489-0738