Provider Demographics
NPI:1336730985
Name:J ROBERT PADBERG, PHD
Entity Type:Organization
Organization Name:J ROBERT PADBERG, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PADBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-451-2771
Mailing Address - Street 1:1570 FISHINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2114
Mailing Address - Country:US
Mailing Address - Phone:614-451-2771
Mailing Address - Fax:614-451-4117
Practice Address - Street 1:1570 FISHINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2114
Practice Address - Country:US
Practice Address - Phone:614-451-2771
Practice Address - Fax:614-451-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty