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ILHAM DERHAN PUTRA
NPI 1770110389
Pathology - Anatomic Pathology & Clinical Pathology in New York, NY

Active since March 24, 2020PECOS Enrolled
525 E 68TH ST, NEW YORK, NY 10065(813) 789-3508 Get Directions Write a Review

NPPES record last updated: June 25, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ilham Derhan Putra NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ILHAM DERHAN PUTRA (NPI 1770110389) is an individual anatomic pathology & clinical pathology provider in New York, New York, licensed in New York (337333-01) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770110389
Entity TypeIndividualMale
Primary Taxonomy207ZP0102X
Provider Legal NameILHAM DERHAN PUTRA
Location Address525 E 68TH STNew York, NY 10065-4870
Mailing Address525 E 68th StNew York, NY 10065-4870
Phone(813) 789-3508
Sole ProprietorYes
Enumeration DateMarch 24, 2020
Last NPPES UpdateJune 25, 2026
NPPES CertifiedJune 25, 2026
✔ NPI 1770110389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
License✔ Licensed in NY · 337333-01
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
525 E 68TH ST, New York, NY 10065
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ilham Derhan Putra is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10065 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$150.24 typical visit price
range $65.69 – $198.19
Typical copayment $37.56 (range $16.42 – $49.54)
Most-billed visit code 99204
Established Patient
$114.88 typical visit price
range $21.20 – $160.66
Typical copayment $28.72 (range $5.30 – $40.16)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AKILI HINSON M.D.
Surgery
525 E 68TH ST
NEW YORK, NY 10065
New York County (212) 746-5454
ABBY AVGERINOS
Nurse Practitioner (Adult Health)
525 E 68TH ST
NEW YORK, NY 10065
New York County (610) 742-3894
DR. PAMELA JOAN-YIN TIEU M.D.
Hospitalist
525 E 68TH ST
NEW YORK, NY 10065
New York County (212) 746-5454
JENNIFER ANNE SOO HOO MD
Physical Medicine & Rehabilitation (Sports Medicine)
525 E 68TH ST
NEW YORK, NY 10065
New York County (212) 746-1500
WEILL MEDICAL COLLEGE OF CORNELL
Specialist
525 E 68TH ST
NEW YORK, NY 10065
New York County (212) 746-2846
MS. RACHAEL HALEY BLAIRE PA-C
Physician Assistant
525 E 68TH ST
NEW YORK, NY 10065
New York County (480) 221-9894
DR. NISHA MEHTA-NAIK M.D.
Psychiatry & Neurology (Psychiatry)
525 E 68TH ST, MAIL SLOT 140
NEW YORK, NY 10065
New York County (212) 746-3720
POOJA SHAH SALVI
Student in an Organized Health Care Education/Training Program
525 E 68TH ST
NEW YORK, NY 10065
New York County (646) 962-8413

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ilham Putra's NPI number?

The NPI number for Ilham Putra is 1770110389. It was assigned to this individual provider in the NPPES registry on March 24, 2020.

Where is Ilham Putra located?

Ilham Putra practices at 525 E 68th St, New York, NY 10065. The listed phone number is (813) 789-3508.

What is Ilham Putra's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Ilham Putra enrolled in Medicare?

Yes. Ilham Putra is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ilham Putra was last updated on June 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 40 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.