Provider Demographics
NPI:1699485284
Name:JAY ITALIYA, MD, PLLC
Entity type:Organization
Organization Name:JAY ITALIYA, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:BHAGWAN
Authorized Official - Last Name:ITALIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-458-3608
Mailing Address - Street 1:3916 TUMBRIL LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13747 MONTFORT DR STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4454
Practice Address - Country:US
Practice Address - Phone:972-200-2426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty